Objective: We assessed the influence of race/ethnicity and provider communication on overweight and obese patients' perceptions of the damage weight causes to their health. Methods: The study included 1071 overweight and obese patients who completed the 2002 Community Health Center (CHC) User survey. We used logistic regression analyses to examine determinants of patients' perceptions of the impact of their weight on their health. Models were adjusted for covariates and weighting was used to account for the sampling design. Results: Forty-one percent of respondents were overweight and 59% were obese. Non-Hispanic Blacks and Hispanics were half as likely as non-Hispanic Whites to believe weight was damaging to their health while controlling for covariates. Overweight/obese CHC patients who were told they were overweight by healthcare providers were almost nine times more likely to perceive that weight was damaging to their health compared to those not told. Conclusions: We observed large racial/ethnic disparities in the perception that overweight is unhealthful but provider communication may be a powerful tool for helping patients understand that overweight is damaging to health. Practice implications: Given obesity is a national epidemic, further attention to the role of patient provider communication in illness is essential with important implications for both health professional training and health care provision. © 2008 Elsevier Ireland Ltd.