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Background: Body image refers to an individual's emotional attitudes, perceptions and beliefs regarding their own body and has a bearing on their nutritional status, which can have far-reaching consequences on their health as adults. Aim: To document body image perception and assess nutritional status among adolescents in a rural school in India. Methods: A cross sectional study was conducted among students at a government high school in Ramnagara District of Karnataka State in India. A self-administered validated questionnaire was used to document body image perceptions, self- estimation of body size and body image dissatisfaction. Height and weight were recorded and WHO BMIfor- age Growth Charts (5-19years) were used to determine nutritional status. Results: A total of 118 subjects were studied, two thirds of whom were girls. The median age was 14 years. 63% of subjects had normal BMI for age, 32% were under-nourished and 5% were overweight and obese. 53% of subjects wished they were thinner and 52% taller. 79% were found to have body image dissatisfaction. 70.3% of undernourished adolescents perceived themselves to be normal, while 66.7% of overweight adolescents perceived themselves to be normal. Adolescents who were malnourished were 7.2 times more likely to have an erroneous body size estimation compared to those who were normally nourished. Conclusion: Dual Burden of under-nutrition and over-nutrition exists among these adolescents. Proportion of adolescents with negative body image perceptions and body image dissatisfaction was high. School health programs need to incorporate counseling for those with negative body image perceptions, while emphasizing healthful nutrition for adolescents. [ABSTRACT FROM AUTHOR]