This study assessed actual and perceived health status of overweight Mexican American clients at a central Texas school-based health center in a predominately Hispanic school district. It also explored the participants' interest in making lifestyle changes to promote a healthy weight. A medical records review indicated that of the Hispanic children between the ages of 7 and 12 years, 38% had a weight status at or above the 85th percentile. Assessments were conducted in a sample of these overweight Mexican American children to learn about their medical history, eating and activity patterns, perceived health and body size, and general health-risk status. Weight-related conditions, such as elevated blood pressure and cholesterol levels, were found in more than half the sample. Few consumed fruits and vegetables, and many engaged in only sedentary activities. The majority perceived themselves as "big," wanted to make changes in their body size, and wanted family members to participate in making changes with them. Although most of the sample were in the 97th body mass index percentile, many perceived themselves to be as healthy as or healthier than others. These findings substantiate the need to design and implement a culturally appropriate weight management and obesity prevention program in this community. However, the perception of being healthy in the presence of multiple indicators of poor health may pose challenges to successful intervention. (Contains 4 tables.)