Body image is a multidimensional construct about one’s appearance. Social and media factors contribute to dissatisfaction and are associated with mental health disorders. In adolescence, obesity emerges as a significant factor, with a four-fold increased risk of body dissatisfaction. Muscle dysmorphia is characterized by an obsessive pursuit of muscularity and distorted body image. A 16-year-old male with a history of obesity and depression, medically accompanied since age 10, developed obsessive behaviors around diet and exercise after weight loss and remission of depression. He adopted a “bulking and cutting” regimen and used creatine, protein, and caffeine supplements. He displayed rigid behavior, with poor insight. Given the pervasive functional impairment, he was referred to child and adolescent psychiatry. Muscle dysmorphia, classified as a body dysmorphic disorder, is underdiagnosed. Adolescent obesity may be a predisposing factor. Early recognition, particularly in adolescents with obesity and body image concerns is crucial for healthy development.