Objectives: African American women experience greater difficulties in physical function and disproportionately higher rates of obesity compared to other racial–ethnic gender groups; however, positive body perceptions may buffer against negative psychological and health-related outcomes associated with functional decline. Method: Associations among satisfaction with and importance placed on body shape and function, body mass index (BMI), physical function, general health, pain, and emotional well-being were assessed among an urban-dwelling, community-based sample of African American women ages 65 and older (n = 111). Results: Higher BMI was associated with worse health and physical function and lower satisfaction with body shape and function. Body perceptions moderated the association between physical function and 2 health-relevant outcomes: pain and emotional well-being. Women who were functioning well and reported high importance of body shape and function demonstrated the lowest levels of pain and highest levels of emotional well-being, and women low in physical functioning who were low in satisfaction with body shape and function had the highest levels of pain. Conclusions: These findings provide evidence that there is significant variation among African American women and risk for negative health outcomes, particularly for women with varying perceptions of body functionality and body satisfaction.