Using the Social Ecological Constraints model, a qualitative multiple case study design was used to explore experienced and committed middle school physical education teachers' perspectives on overweight and obese students (OWS), and how and why they acted to include OWS in physical education and physical activity opportunities in their school environments. Three themes emerged. 1) OWS are "the same, but different." Teachers attempted to treat all students the same, but perceived variations among OWS' participation in PE and related individual constraints. 2) Teachers' concerns lead to individual goals and specific actions. Teachers identified specific goals and approaches to help individual OWS who needed extra attention. 3) OWS are a responsibility and challenge. Many of these teachers felt a responsibility to devote extra time and effort to help struggling OWS to succeed. These teachers avoided obesity bias, and exhibited beliefs and actions similar to a caring perspective.