We developed two gender specific sets of body-size silhouettes for evaluating body image in African Americans; 370 clinic-based adult participants with diabetes were queried on body image, perceptions, current efforts to change weight, and psychosocial variables. Comparisons were made by weight group and sex after classification as overweight or not overweight according to body mass index (BMI). Regardless of sex or weight category, perceived current body size was significantly related to BMI. Both men and women who were classified as overweight selected a desired body size that was significantly smaller than their perceived current size. Men, however, were more likely than women to select a larger desired size relative to their current size. Both men and women expected the dietician to favor a body size smaller than their own desired size and felt their designated important adult would choose the same desired size that they selected. Given the importance of cognitive perspectives in understanding weight management, it may be useful to incorporate body image measures into both observational and interventional studies.