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Simple Summary: There is a growing need to clarify the effect of modifiable lifestyle factors such as obesity on outcomes of multiple myeloma (MM). In this paper, we examined the associations between body mass index (BMI) at different periods of life up to the time of diagnosis and overall survival among patients newly diagnosed with multiple myeloma. The key findings are that BMIs before and at the time of diagnosis were not associated with overall survival in MM, except that a higher BMI at diagnosis was associated with a better overall survival for females, irrespective of race/ethnicity. This is the first evidence that the BMI-survival association may differ by sex. Obesity is associated with survival in several solid tumors and non-Hodgkin lymphoma, but its impact on multiple myeloma (MM) survival is unclear. We examined the associations between body mass index (BMI) at different periods of life up to the time of diagnosis and overall survival (OS) among 563 patients newly diagnosed with MM in 2010–2019. BMI at diagnosis was calculated using measured height and weight from electronic medical records (EMR). BMIs at age 20, maximum during adulthood, and 5 years before diagnosis were calculated using self-reported weights and measured height from EMR. Over a median follow-up of 49.3 months, 191 (33.93%) deaths were identified. We used multivariable Cox proportional-hazards models to examine the associations between BMIs and OS. Height as well as BMI before and at diagnosis was not associated with OS, but there is a U-shape association between weight and OS. Higher BMIs at diagnosis were associated with better OS among females (HR = 0.39 [0.22–0.71]), irrespective of race. In conclusion, our results suggest that BMI at different periods of life up to the time of diagnosis may not be associated with OS in MM, except that a higher BMI at diagnosis was associated with superior OS for females. [ABSTRACT FROM AUTHOR]