The widespread pursuit of a thin physique may have a detrimental impact on the wellbeing of preadolescents. The influence of body image distortions on the lifestyles, dieting behaviors, and psychological factors was investigated in 631 fifth and sixth grade children in Kyeonggi-do, Korea. Children were classified into three weight groups (underweight, normal, and overweight) and three perception groups (underestimation, normal, and overestimation). Necessary information was obtained by questionnaire, and each subject's weight status was determined by the Röhrer index calculated from the annual measurement records, which were obtained from the school. According to their current weights, 57.4% of children were normal and 32.2% were overweight or obese, 16.6% of the children overestimated their body weight, and 55.2% had an undistorted body image. Overweight children had desirable lifestyles and dietary habits and presented reasonable weight control behaviors. Compared to those without distortion, the overestimated group had greater interest in weight control ( P = 0.003) and dissatisfaction with their body weights ( P = 0.011), presented unhealthy reasons to lose weight ( P = 0.026), and had higher scores for "feeling sad when comparing own body with others" ( P = 0.000) and for "easily getting annoyed and tired" ( P = 0.037), even though they had similar obesity indices. More subjects from the overestimation group ( P = 0.006) chose drama/movies as their favorite TV programs, suggesting a possible role for the media in body image distortion. These findings suggest that body image distortion can lead preadolescents to develop stress about obesity and unhealthy dieting practices, despite similar obesity indices to those without distorted body images. These results emphasize the importance of having an undistorted body image.