Introduction: Obesity is known to be associated with several comorbidities, including cancer. Reduced fat mass, healthy eating and regular exercise are known ways to minimize obesity-associated inflammation, which is an underlying pathophysiologic mechanism of disease development. It is unknown if obese adults in the United States understand the significance of these lifestyle choices on cancer development. We aimed to evaluate the perception of obese US adults on the influence of obesity, healthy eating and regular exercise on the development of cancer. Methods: We analyzed the 2018 Health Information National Trends Survey (HINTS 5 Cycle 2). Our analytical cohort identified 2,986 respondents in the US (weighted population size = 219,552,371). Respondents rated how much they thought the following factors had an influence on whether a person will develop cancer: (1) Being overweight or obese, (2) Eating healthy food, and (3) Exercising regularly. We used logistic regression analyses to examine the association between respondent BMI categories and whether respondents believed each factor substantially influenced the development of cancer. We used survey weights in all analyses. We calculated odds ratios (OR) and 95% confidence interval (CI). Results: The mean age of the cohort was 48.4 years, 50.1% female, 66.1% White, 10.3% Black, 15.9% Hispanic, 15.8% current smokers, 27.9% with a yearly household income less than $35,000 and 30.4% had a high school education or less. The perception of obese respondents was generally lower in agreeing that these putative risk factors (obesity, healthy eating, and regular exercises) affect cancer development and was statistically significantly lower with identifying obesity as influencing cancer development (Table 1). Conclusion: There is a general suboptimal knowledge about factors that influence cancer development among adults in the United States. This is particularly worse among obese subjects. There is a need for healthcare providers and public health officials to educate the population at large about risk factors for cancer development, particularly among obese subjects. Table 1. - Perceived risk of lifestyle choices on cancer development among US adults by BMI categories Adjusted for age, sex, education, marital status, health insurance, smoking, income, and race Perceived risk on cancer Normal BMI (< 25 kg/m2) Overweight (25-29.9 kg/m2) Obese (≥30 kg/m2) N (%) OR (95% CI) N (%) OR (95% CI) N (%) OR (95% CI) Obesity has a lot of Influence (Yes) 369 (39.2) Reference 349 (29.5) 0.68 (0.45-1.02) 294 (24.6) 0.51 (0.33-0.80) Healthy Eating has a lot of Influence (Yes) 492 (48.0) Reference 470 (42.3) 0.89 (0.58-1.36) 435 (40.5) 0.87 (0.59-1.28) Regular Exercise has a lot of Influence (Yes) 420 (41.3) Reference 411 (36.2) 0.82 (0.56-1.19) 377 (32.7) 0.74 (0.53-1.03)