Background Over the past few decades, the prevalence of obesity in the United States has steadily increased with the proportion of obese Americans projected to be about fifty percent in 20301. With more than half of adults being overweight or obese (OW/OB), an increasing number of adults failed to accurately perceive body weight, which may be a major barrier to weight loss strategies, thus, presenting a substantial challenge to prevention efforts.  The objective of this study was to assess the dynamic trend of body weight related self-perception among American adults and provide recommendations for improving obesity prevention strategies. Methods Data were collected from NHANES 1988-1994 (n=11,037), 1999-2004 (n=8,843), 2007-2012 (n=7,483). All participants (ages 20-59) had anthropometric data collected. Data used in this study were collected through in-person interviews and standardized physical examinations. Results The percentage of OB/OW women who appropriately perceived themselves as overweight declined from 87% in the early survey to 79% (intermediate) and to 77% (recent survey). For self-perceived overweight White women, the BMI distributions shifted right; however, for Black women, the distribution shifted as a whole, which increased from 26.3 (26.1, 26.5) to 26.8 (26.3, 27.3) and further 27.7 (27.3, 28.1). Conclusion Despite a continuous rise in obesity rates, the tendency to correctly self-perceived as overweight among OW/OB adults declined, thus the gap between reality and perceptions about their body weight among adults inflated. A shift of BMI threshold for self-perceiving as overweight occurred among all three major racial/ethnic groups except for White women.