OBJECTIVE: QOL is an important outcome in the evaluation of weight loss interventions (e.g., drug therapy). The objective of this study was to determine whether there are country-specific differences in the perception of the impact of weight on quality of life (QOL) or comfort with food. METHODS: The Impact of Weight on Quality of Life Scale (IWQOL) was administered to a sample of 2144 obese individuals [Mean body mass index (BMI) =31.3, 63% > = 1 self-reported comorbidity, mean age = 41 years, 58% female] in Germany (n = 542), Italy (n = 503), United Kingdom (UK) (n = 539), and United States (n = 560). The IWQOL consists of 74 items forming 8 subscales: Health, Social/Interpersonal, Sexual Life, Work, Self-Esteem, Mobility, Activities of Daily Living, and Comfort with Food. For each country, Pearson correlations were calculated between demographics and IWQOL scores. To control for demographic differences in country-specific samples, differences in IWQOL scores were tested using analysis of covariance controlling for BMI, total number of self-reported comorbidities, gender, and age. RESULTS: Correlations between demographics and IWQOL subscales across countries followed a similar pattern, but the correlation coefficients calculated for Germany between most IWQOL subscale scores and BMI or total comorbidities were significantly (p <0.05) higher. Significant (p <0.05) country differences were found for all IWQOL scales. Pairwise comparisons showed, for example, that, compared to the other three countries, the UK sample had significantly better Esteem and Mobility scores; Germany had significantly worse Social/Interpersonal scores; and Italy had significantly less comfort with food (all p <0.05). CONCLUSIONS: Differences in the perceived impact of weight on QOL found in this study suggest the need for more research investigating cultural differences in the perception of obesity. Such differences may impact the interpretation of patient-reported outcome scores obtained in international evaluations of obesity interventions.