The World Health Organization has argued that greater efforts are needed to prevent and manage childhood obesity. In urban cities, the Black sub-group of Afro-Caribbeans has a high rate of childhood obesity and overweight. The purpose of this study was to analyze Afro-Caribbean mothers' cultural perceptions in London and New York regarding childhood weight and food practices in children age 6 to 12 years. This qualitative content analysis, guided by the Developmental Niche, used a purposive sample of 30 Afro-Caribbean mothers to illuminate cultural perceptions of food and weight in their children. Semi-structured in- depth interviews were conducted with 15 mothers in both London and New York City. Each participant completed a demographic questionnaire that also included two quantitative questions. The first measured mother's perception of weight using a visual image and the other assessed the written description of the child's weight. The eight themes that emerged were: perceptions of childhood obesity within the general population; parents' role in child obesity; physical activity (PA); weight of child; cooking techniques; types of food consumed; food is a social bond that connects child with others; and food preparation varies according to families. Additionally, there were 29 subthemes such as: extracurricular PA is expensive, lack of knowledge about what constitutes a healthy weight, health care provider's involvement, cultural techniques modified and eating as a way to maintain cultural rituals. More than one-quarter of the mother's (27%) in both London and New York had overweight or obese children. In general, mothers tended to select a visual image that showed their children at a lower weight than their actual size. Furthermore, most mothers of overweight and obese children did not perceive their children as such in their responses to the visual images. The implications for nursing practice and future research include increasing cultural competence for nurses, health care providers and students; increasing parent education regarding healthy food substitutes and weight recognition; developing policies to increase physical education for children; and providing weight and nutrition interventions to the extended family.