Internalization of a thin ideal has been posited as a key risk factor in the development of pathological eating attitudes. Cross-culturally, studies have found a preference for heavier bodies in populations with reduced access to visual media compared to Western populations. As yet, however, there has been little attempt to control for confounding variables in order to isolate the effects of media exposure from other cultural and ecological factors. Here, we examined preferences for female body size in relation to television consumption in Nicaraguan men and women, while controlling for the potential confounding effects of other aspects of Westernization and hunger. We included an urban sample, a sample from a village with established television access, and a sample from a nearby village with very limited television access. The highest BMI preferences were found in the village with least media access, while the lowest BMI preferences were found in the urban sample. Data from the rural sample with established television access were intermediate between the two. Amongst rural women in particular, greater television consumption was a stronger predictor of body weight preferences than acculturation, education, hunger, or income. We also found some evidence for television consumption increasing the likelihood of women seeking to lose weight, possibly via body shape preferences. Overall, these results strongly implicate television access in establishing risk factors for body image disturbances in populations newly gaining access to Western media.