ObjectiveTo investigate how patient perception of procedural fairness in primary care physician communication among diverse patients with obesity is associated with the patient’s willingness to follow recommendations, self-efficacy beliefs, and lifestyle behaviors. Methods We conducted a cross-sectional, secondary data analysis of 484 primary care patients (43.6% Black, 40.7% Hispanic/Latino, 56.4% Female, Mage=50 years) with a BMI ≥ 25 kg/m2 enrolled in a weight management study in two New York City healthcare systems. To evaluate direct and indirect associations between PF and outcome variables, we used ordinary least squares path analyses with bootstrapping procedures controlling for age and gender. Results Patients who perceived their primary care physician as fairer reported higher willingness to follow recommendations and higher dietary self-efficacy, which were associated with healthier dietary behaviors (willingness: indirect=.08, SE=.03; 95% CI[.04 to .14]; dietary self-efficacy: indirect=.03, SE=.01; 95% CI[.01 to .05]). Higher perceived PF was also associated with higher exercise self-efficacy, which was associated with increased physical activity (indirect=.03, SE=.01; 95% CI[.01 to .05]).ConclusionPF was associated with lifestyle behaviors via willingness to follow recommendations and self-efficacy beliefs. PF holds promise as a novel communication target to enhance patient-physician communication related to weight management in primary care.