OBJECTIVE: Adults who are overweight or obese are at greater risk for other serious health conditions and self-report a variety of negative impacts on quality of life, including low self-esteem, social stigma and many bothersome physical symptoms. This analysis explores the relationship between symptoms and physically linked quality-of-life scores with comparisons made between BMI levels. METHODS: Through Knowledge Networks, a web-based TV survey panel similar to the national population, an adult sample of 1348 obese persons (BMI 30 or higher) and 1157 persons (BMI less than 30) were prospectively and randomly selected. Using the newly developed Weight-Related Symptom Measure (WRSM), we obtained self-reported data for a list of 20 physical symptoms. Quality of life was measured by the Obesity and Weight Loss Quality of Life Measure (OWLQOL). For each symptom, we identified the differences in the physical health subscale of the OWLQOL for those reporting and not reporting the symptom and then compared those results between BMI groups. RESULTS: For all symptoms, there was a significant difference in scores on the physical health subscale of the OWLQOL between those who reported the symptom (55.9 to 89.7) and those who did not (73.8 to 95.9), indicating higher quality of life for those not reporting symptoms. Those reporting each symptom demonstrated highly significant differences between high (55.9 to 69.2) and low BMI groups (82.5 to 89.7) for physical health related QOL, indicating higher QOL for those with lower BMI levels. CONCLUSIONS: While the physical symptoms that occur frequently in obese populations can also be experienced by those with low BMI scores, there is a far greater tendency for them to be reported in individuals with BMI scores greater than 30, and a significantly greater negative impact of these same symptoms on the QOL of those who have BMI scores of 30 or more.