Obesity is not only a matter of accumulation of adipose tissue but also a projection of self-cognition. This study examined the association between low self-esteem and visceral obesity; visceral adipose tissue (VAT) and visceral adipose tissue /subcutaneous adipose tissue ratio (VSR). Methods This cross-sectional study was performed in pre-menopausal obese(BMI ≥ 25 kg/m2) women in Seoul, from 2007 to 2008 (n=54). Simple anthropometry including BMI and waist circumference and Computed Tomography (CT) including VAT and VSR were done. To measure self-esteem, Rosenberg self-esteem scale (SES) questionnaire was administered. Subjects were given written consent and this study was performed under the permission of institutional review board of Kyung-Hee East-west Neo Medical Center. Results There was a significant relationship self esteem (SES score) with visceral obesity (VAT and VSR). 1. SES was correlated with VAT (r=-0.377, p<0.01) and VSR (r= -0.400, p<0.01) significantly by Pearson Correlation. 2. VAT and VSR could be predicted from SES by Simple linear regression. VAT = -1.701 x (SES score) +161.191 (R2=0.142) VSR = -1.09x10-2 x (SES score) +0.858 (R2=0.160) Conclusions This study proves that low self-esteem might contribute to visceral obesity in Korean pre-menopausal obese women. Self-esteem and psychological factor should be considered in treatment of visceral obesity in adult-women.