Self-rated health (SRH) is crucial for predicting morbidity and mortality across age groups, including adolescents and adults. Body image dissatisfaction, measured by difference between current and ideal weight, surpasses Body Mass Index (BMI) in predicting health outcomes. We evaluated the correlation between body image perception and SRH among middle and high school students in Korea.This study used data from the 2022 Korea Youth Risk Behavior Web-based Survey (KYRBS), conducted by the Korea Disease Control and Prevention Agency between August 29 and October 25, 2022. The KYRBS is an annual, nationwide survey of students from the first year of middle school to the third year of high school.Subjective health status was categorized into  'good' or 'poor' groups. Body image was classified into 'underweight,' 'normal,' or 'overweight'. BMI was determined using age-specific percentiles: underweight (<5th), overweight (85th-95th), and obese (>95th). Data analysis was performed by multivariable logistic analysis and adjusted for depressive mood, stress, and socioeconomic status.  All analyses were performed using SPSS Statistics version 27.0 (IBM Crop. Armonk, NY, USA).The total participants (N=50,455) included 59.4% with normal weight according to BMI, only 36.4% perceived themselves as normal. Students who perceived themselves as having a normal weight had higher rates of good SRH compared to others. Excluding females with BMI ≥25kg/m², both genders showed higher odds ratios for poor SRH when perceiving themselves overweight (Male: OR 2.57, 95% CI 2.367 – 2.782; Female: OR 1.36, 95% CI 1.270 – 1.452) or underweight (Male: OR 1.64, 95% CI 1.507 – 1.791; Female: OR 1.36, 95% CI 1.256 – 1.472).This study is meaningful in that it examined the relationship between body image perception and self-rated health using large-scale, nationally representative data. Self-rated health is known to be one of the strongest predictors of healthcare utilization, medical costs, and mortality, and poor self-rated health in adolescence has been reported to influence health outcomes in adulthood.More than half of the students responded negatively to their body image, associated with poor subjective health status. Therefore, promoting accurate body weight perceptions will play a positive role in overall health of adolescents.