Immigrant adolescents represent a significant and growing proportion of the population in the United States. Yet, little is known about their experiences of body image distortion. This is particularly concerning given that body image distortion has been identified as a significant and modifiable risk factor for a number of mental illnesses, including depression and eating disorders. This study uses multi-level modeling to examine the associations between immigrant generational status, neighborhood immigrant concentration, sex, body dissatisfaction and risk for body image distortion. Data come from the National Longitudinal Study of Adolescent Health and includes 10,962 11–19 year olds (49.6 % female). First generation immigrant females were significantly more likely than 3rd generation-or-later adolescents to experience underweight body image distortion. There was no association between neighborhood immigrant concentration and risk for body image distortion. Body dissatisfaction was associated with greater risk for underweight and overweight body image distortion, with the magnitude of underweight distortion risk significantly greater among 1st generation immigrants. Interventions that encourage the development of a healthy body image have the potential to reduce the onset and duration of body image distortion among immigrant and non-immigrant adolescents.