Background. Body mass index does not capture obesity or cardiovascular disease risk in small, limited samples of people with SCI. Objectives. (1) To determine sensitivity of the current BMI cut-off for obesity in a representative sample of persons with SCI; (2) To explore the feasibility of developing a more sensitive BMI cut-off for obesity based on percent fat mass (%FM) and C-reactive protein (CRP). Methods. A cross-sectional study of 77 adults with chronic SCI involved collection of anthropometric and biological data. Statistical analyses included sensitivity analyses, piecewise regression, non-linear regression, and receiver operator characteristic curves. Results. BMI cut-off of 30 kg/m2 fails to identify 79.5% of obese participants compared to 26.1% at 25 kg/m 2. BMI cut-offs determined from risk levels of %FM and CRP ranged from 22.1 kg/m2-26.5 kg/m2. Conclusions. People with SCI and BMI values greater than 22 kg/m2 should be identified as at high risk for chronic disease.