The purpose of the present study was to use a biopsychosocial approach to investigate the role of body image concerns and appearance-related evaluation stress in the relationship between adiposity and cardiovascular reactivity and recovery. Participants included 106 Caucasian female undergraduates at the University of South Florida. The laboratory procedure consisted of resting baseline, speech preparation and delivery, and recovery phases. Participants also completed a variety of body image questionnaires. To manipulate appearance-related evaluation stress, participants were randomly assigned to present their speech to a video camera or an audio recorder. Overall adiposity was measured as body mass index (BMI) and central adiposity was measured as waist-to-hip ratio (WHR). Greater adiposity was associated with more weight-related anxiety during the speech task, regardless of speech condition (BMI: r = .54, p < .001; WHR: r = .44, p < .001). Additionally, those in the video condition reported more weight-related anxiety (M = 9.28, SD = 7.74) during the speech task than those in the audio condition (M = 3.31, SD < 5.61; F(1,99) = 19.73, p < .001). Significant relationships between adiposity and CVR and recovery emerged for several outcome measures with central and overall adiposity predicting different CVR patterns (all ps < .05). There was no main effect of speech condition on CVR or recovery (all ps > .05). Significant interactions between adiposity and speech condition emerged for some of the outcome variables as well (all ps < .05). Additionally, body image concerns mediated the relationship between adiposity, speech condition, and CVR for SV and CO reactivity. The results suggest that adiposity may have a robust effect on physiological reactivity and recovery independent of psychological processes that co-occur. The results also suggest that those with high adiposity experience more weight-related anxiety during evaluation, even when the evaluation is not intended to induce body image concerns. Finally, the results suggest that body image concerns may act to suppress reactivity among those with high levels of weight-related anxiety. Implications and future directions for research are discussed.