Obesity and related chronic illnesses are leading causes of death and excessive health care costs, necessitating identification of factors that can help patients achieve and maintain healthy weight. Greater self-efficacy and perceived spousal support in patients have been associated with successful weight management. The current study also assesses self-efficacy and perceived support in spouses and whether these factors are related to patient weight. At baseline of a spousal support trial, patients and spouses (N = 255 couples) each completed measures of self-efficacy and spousal support for their own exercise and healthy eating behaviors. We fit a multivariable regression model to examine the relationship between these factors and patient weight. Patients were 95% males and 65% Whites, with average age of 61 years (SD = 12) and weight of 212 lbs (SD = 42). Spouses were 64% Whites, with average age of 59 years (SD = 12). Factors associated with lower patient weight were older patient age (estimate = -0.8 lbs, p < .01), normal blood pressure (estimate = -17.6 lbs, p < .01), higher patient self-efficacy for eating healthy (estimate = -3.8 lbs, p = .02), and spouse greater perceived support for eating healthy (estimate = -10.0 lbs, p = .03). Future research should explore the causal pathways between perceived support and health outcomes to establish whether patient support behaviors could be a point of intervention for weight management.