Abstract  Objective To assess body size perception among African American women using cultural definitions of body size terms.  Methods Sixty-nine African American women classified Body Image Scale figures as overweight, obese, and too fat, and independently selected the figure they considered closest to their current body size.  Results Body size classifications of figures did not vary by participant weight status. Overweight figures were not considered too fat. For 86% of overweight (body mass index [BMI], 25–29.9) women and 40% of obese (BMI > 30) women, the self figure was not defined as overweight, obese, or too fat. Among participants with BMI ≥ 35, 65% did not classify their self figure as obese and 29% did not classify their self figure as overweight.  Conclusions and Implications The difference between cultural (folk) and medical definitions of body size terms may serve as a barrier to effective communication between patients and providers about health effects of excess adiposity. http://www.sciencedirect.com/science/article/pii/S1499404614000979