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This study investigates the associations between body mass index (BMI), socio-economic status (SES) and related socio-behavioral practices including marriage and market visits in a population of adult Tz'utujil Maya women in Santiago Atitlán, Guatemala, aged 18-82. Mixed qualitative and quantitative methods include cross-sectional anthropometric measurements and semi-structured interviews gathered in 2007, as well as participant observation and purposive interviews conducted in 2007-2008. The regional quota sample of 53 semi-structured interviews was designed to be representative of the cantones (municipal divisions) of Santiago Atitlán. BMI was positively associated with years of schooling, income and literacy, all measures of SES. A statistical analysis of our data indicates that increased income, increased market visits and being married are significantly positively associated with BMI. Qualitative analysis based on the grounded theory method reveals relevant themes including a preoccupation with hunger and undernutrition rather than obesity, a preference for food quantity over dietary diversity, the economic and social influence of a husband, the effects of market distance and the increasing consumption of food from tiendas. These themes help to explain how SES, socio-behavioral practices and BMI are positively associated and can inform future public health interventions related to obesity and undernutrition.