BACKGROUND: Obesity disproportionately affects African Americans and leads to several major co-morbidities. While guidelines recommend physicians identify obese patients and counsel them on weight management, little is known about how these efforts are received by patients. OBJECTIVE: To elucidate how obese, urban African American patients perceive the physician role in the treatment of obesity and to identify specific provider behaviors that may motivate or hinder attempts at weight loss. DESIGN: Qualitative study involving eight focus groups. PARTICIPANTS: Forty-three obese African-American patients recruited from academic internal medicine practices participated in focus groups between September 2007 and February 2008. MEASUREMENTS AND MAIN RESULTS: Four broad themes emerged: (1) dislike of the word obese, (2) importance of the physician manner and timing when discussing weight, (3) necessity of a personalized approach in discussing weight management issues, and (4) variable response to scare tactics. Within each theme participants identified specific physician behaviors that were perceived as either motivating or hindering attempts at weight loss. CONCLUSIONS: Physicians must be cognizant of the potential unintended consequences of the techniques they use to educate and counsel African-American men and women on obesity, particularly those that may be perceived as negative and act to further alienate obese patients from seeking the care they need.