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BMI cut-offs were used in conjunction with the Children‘s Body Image Scale to provide a comparison between actual BMI and perceived and ideal body images among 90 low socioeconomic children aged seven to 10 years. A third of the sample was classified as overweight or obese, with a higher incidence among boys (38% versus 28% for girls). Two-thirds underestimated their current body size and only around 5% considered themselves overweight or obese. Just over 70% selected an underweight ideal body size. Intervention developers thus face the dual challenge of providing children and their families with the information and skills they need to prevent childhood obesity while addressing a lack of awareness of actual body weight among children that is combined with an unrealistic ideal body size preference. This task is complicated by the need to minimise weight concerns that can result in eating disorders. The results suggest the need for a family-based approach that targets parents of young children to increase awareness of healthy body sizes and lifestyle behaviours before children have become overweight, formed inaccurate weight-related beliefs, and/or become dissatisfied with their bodies.