Objectives: Examine the prevalence of body weight perception discordance, and its relationship with physical activity and mental health among college women. Participants and methods: Data were collected from a convenience sample of female undergraduates enrolled in general education health and wellness courses at a large, northeastern United States university (n = 1607) via direct email using previously validated measures that assessed: demographics; physical activity; weight goals and perceptions; mental health and sleep; and, physical activity enjoyment, self-efficacy, and goal setting. Analyses included one-way analysis of variance analyses and chi-square tests for independence. Results: Though most women had accurate weight status perceptions (n = 987, 62.6%), there was a tendency to overestimate weight status (n = 482, 31.2%) that was associated with greater depressive symptoms. Conclusion: A relatively large minority of women demonstrated discordant weight status perceptions, which were associated with adverse mental health outcomes. Colleges should consider improving healthy weight status perception education among women to improve mental health.