Background: Previous studies demonstrate a relationship between body dissatisfaction and substance use and suicidal ideation among older adolescent girls and young women while less documentation exists for early adolescence. This study explored the relationship between reported weight loss attempts and substance use history and suicidal thoughts among younger female adolescents. Methods: Participants (n = 1656) were middle school female students who participated in the 2019 Youth Behaviors Risk Survey. Participants were coded as "Trying to lose weight" and "Not trying to lose weight." Two hierarchal multiple binary logistic regressions were conducted, 1 for each of the dependent variables: (1) substance use history and (2) suicidality. Results: Fifty-seven percent of the participants were trying to lose weight, 40% reported suicidal thoughts and 45% reported substance use history. Trying to lose weight was a significant predictor for both substance use (p < 0.01) and suicidality (p < 0.001). Conclusion: Body dissatisfaction and its association with risky health behaviors highlight the need for prevention education at earlier ages while reinforcing the need for availability of school counselors.