To describe body size satisfaction and agreement among low-income, urban, African-American adolescents, and female caregivers. Two hundred and fifteen adolescent-caregiver pairs completed measures of demographics, anthropometrics, and body size satisfaction. Adolescent-caregiver agreement on body size satisfaction varied by body mass index (BMI) category. Among normal weight adolescents, 61% of adolescent-caregivers agreed that current body size was ideal. Among adolescents at risk for overweight, 38% of adolescent-caregivers agreed that current body size was ideal, and 38% were discordant with adolescents wanting to be thinner and caregivers satisfied with current body size. Among overweight adolescents, adolescent-caregiver agreement was 67%; 52% agreed the adolescent should be thinner and 15% agreed current body size was ideal. Body size satisfaction is related to BMI category for adolescents and caregivers, but adolescents have a lower threshold. Encouraging caregivers to elicit their adolescents' views on body size satisfaction may enable caregivers to support their adolescents in addressing weight-related issues.