This study examines the psychosocial risks associated with body weight (BMI) and body image in a southeastern, rural Lumbee American Indian community. A total of 134 adolescents (57% female) were surveyed over 2 years at ages of 13 and 15 years. On average, boys (55%) were more likely to be overweight or obese than were girls (31%). BMI was related to a variety of weight control efforts including onset and frequency of smoking, dieting, and body dissatisfaction. Body dissatisfaction was associated with peer relations, self-esteem, anxiety, depression, and somatization in adolescence. Longitudinally, psychological health, peer competence, and ethnic identity were associated with positive body image. In boys, early ethnic identification was associated with the development of later body image. Implications of findings for ethnic- and gender-specific interventions are discussed.