BACKGROUND: Body image (BI) may be important in understanding weight-related attitudes and behaviors in black women. Specifically, body dissatisfaction may mediate the relationship between body mass index (BMI) and weight-related quality of life (QOL) in black women. We examined the relationship between BMI and weight-related QOL in black women and tested for mediation by body dissatisfaction. METHODS: The sample included 149 black women recruited from Birmingham, Alabama, for a one-time clinic visit. BIs were self-reported using the Pulvers figure rating scale. Body discrepancy (BD), a surrogate measure of body dissatisfaction, was calculated as perceived current image minus ideal image. QOL was self-reported using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). Baron and Kenny's test for mediation was conducted where BMI was the predictor, IWQOL-Lite score was the outcome, and BD was the mediator under investigation. RESULTS: Mean age was 40.5 years, and mean BMI was 36.1 kg/m(2). The mean IWQOL-Lite score was 81.1±15.8 out of 100. Participants had a BD score of 2.3, indicating a desire to be two figure sizes smaller than their current perceived body size. Tests for mediation revealed that BD partially mediated the relationship between BMI and IWQOL-Lite scores in this sample. CONCLUSIONS: BD was in the pathway of the association between BMI and IWQOL-Lite scores. BI dissatisfaction may contribute to explaining more about black women's weight-related QOL beyond actual BMI alone. Additional research is needed to better understand black women's perception of weight and subsequent weight-related behaviors.