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Summary   Objective  Prior studies have suggested that weight misperception – underestimating one's actual weight – may be associated with reduced engagement in weight loss programmes, decreasing the success of initiatives to address obesity and obesity‐related diseases. The purpose of this study was to examine the factors associated with weight misperception among Eastern Caribbean adults and its influence on engagement in weight control behaviour.    Methods  Data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study were analysed (adults aged 40 and older, residing in the US Virgin Islands, Puerto Rico, Barbados and Trinidad). Weight misperception is defined as participants who under‐assess their weight measured by body mass index (BMI). Multivariable logistic regression ( n  = 1,803 participants) was used to examine the association of weight misperception with BMI category, age, gender, education, history of non‐communicable disease and attempt to lose weight.    Results  Weight misperception was common, with 54% of overweight (BMI 25–29 kg m −2 ), and 23% of obese class I (BMI 30–34.9 kg m −2 ) participants under‐assessing their actual weight. Participants with higher levels of education, versus lower, had decreased odds of weight misperception (OR 0.5,  p  < 0.001). There were no significantly reduced odds of weight misperception in women versus men (OR 1.13,  p  = 0.367) or in individuals with history of diabetes versus none (OR 0.88,  p  = 0.418). Participants with weight misperception had 85% ( p  < 0.0001) lower odds of attempting weight loss than those with accurate weight perception.    Conclusion  Weight misperception is common among adults with overweight and obesity in the Eastern Caribbean and is associated with lower likelihood of attempting weight loss. Obesity interventions, targeting similar populations, should incorporate approaches for addressing weight misperception to achieve measurable success.

Obesity and weight misperception among adults in the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study