A case control study was conducted to examine the theorized differences for eating and exercise behaviour among the obese and non-obese women from an urban health center in Saudi Arabia. Perceptions regarding actual and ideal body size were also determined. The obese were significantly more likely to eat under emotional conditions of stress and anger, in secrecy, and indulge in binge eating (P < 0.05). Frequent snacking and drinking of regular soda drinks was also more common in this group compared to the controls (P < 0.05). A weak association was observed for nibbling at food without being aware and preference of sweet foods compared to savoury ones by the obese (P < 0.1). A large group of the study population (75%) were either not exercising at all or doing so infrequently--a feature expected in the middle and lower social class group of women in this region. A sizable proportion of women either overestimated (28.6%) or underestimated (28.9%) their actual body weight with increasing education significantly related to overestimation of weight and vice versa (P < 0.05). A change in the concept of an ideal body image from the overweight female to that of the slim figure was also observed with advancing education. To control and prevent obesity in this region, it is suggested that health education related to an awareness of a healthy body size and appropriate eating and exercise behaviour should be given through primary health centers, other health facilities and schools.