UPDATE:
After giving it an extensive road test, I don't recommend this belt at all. I'm subtracting one star, giving it 2/5.
The belt is terribly deformed and the most frequently used holes are stretched and ripped. Not 100% leather, it's cardboard or something inside.
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It's a nice looking belt. The quality is questionable. It almost seems like some kind of card-stock backing and then leather glued to the face. I really hope that's not the case, but I guess time will tell. It's a very stiff belt, almost folds rather than curls. I haven't had a new belt in quite a long time so I hope I'm just too accustomed to my well broken in leather belt. This one says 100% genuine leather... We'll see.

As for sizing, people should be using common sense. It's a belt, not a pair of shoes. If you're a 38 waist, order at least a 40+ belt. The size of the belt is the last (largest) hole. If you don't want to have to wear it on the largest hole, order something a little larger. (This seems obvious to me... I'm not sure why so many people have problems; on every belt here on Amazon there are sizing complaints, it's a mystery.)