OBJECTIVE: This study examined the relationship of psychosocial factors and health behaviors to frequent dieting and purging behaviors in Native American adolescent boys and girls. DESIGN: School-based health survey. SETTING AND PARTICIPANTS: A total sample of 13 454 Native American youth in grades 7 through 12 living on or near reservations from eight Indian Health Service areas completed a self-report, school-based health questionnaire. RESULTS: Almost half (48.3%) of the girls and one third (30.5%) of the boys had dieted in the past year. More than one fourth (28%) of the girls and 21% of the boys reported purging behavior of some type. Dieting frequency and purging status were associated with negative psychosocial factors and health risk behaviors. Dieting frequency in girls was associated with weight dissatisfaction, concerns about being overweight, high emotional stress, binge eating, alcohol use, tobacco use, suicide ideation and attempts, delinquent behaviors, and physical and sexual abuse. Purging status was positively and independently associated with negative psychosocial and health behavior risk factors. There were fewer significant relationships in boys. CONCLUSIONS: Findings from this study suggest that dieting and purging are associated with similar psychosocial factors and health-compromising behaviors in Native American and white youth. Implications for future research and prevention programs are discussed.