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Purpose: To explore associations between adolescent’s concern for their body weight/shape/size and engagement in unhealthy weight control behaviors (UWCBs). Design: Secondary data analysis. Setting: 2022 National Survey of Children’s Health. Subjects: Analyses included 23 357 (51.8% male) adolescents, ages 10-17 years (mean 13.8 ± 2.3 years). Measures: Reported concern for body weight/shape/size, and UWCBs including skipping meals/ fasting; low interest in food; picky eating; binge eating, purging; diet pills; and over-exercising. Analysis: Logistic regression models assessed the odds of engaging in UWCBs by reported concern for body weight/shape/size. Results: Engagement in UCWBs was low with 21.1% reporting picky eating, 13.5% fasting, 11.7% low interest in food, 5.3% binge eating, and <2% purging, over-exercising, or using diet pills. Compared to adolescents who were not at all concerned about their body weight/shape/size, adolescents who were somewhat or very much concerned had significantly higher odds (P’s < 0.05) of engaging in all UCWB outcomes except for using diet pills or laxatives, which was only significant for adolescents who reported being very concerned (OR = 12.74; CI: [19.16, 36.94]). Further, after stratification by gender and age, there was a significant p-for trend (P’s < 0.05), in engagement in UWCBs by concern for body weight/shape/size except for using diet pills or laxatives in 10-11- and 12-14-year-olds. Conclusion: Expressing concern for body weight/image/size is associated with an increased likelihood of engaging in UCWB in adolescents, regardless of gender or stage of adolescence. © The Author(s) 2025