This study examined the relationship between educational year level, regional differences in adolescent girls' body image perceptions, body mass index (BMI), physical activity (PA) level, self-reported health, and dietary behaviour. Also, the role of PA behavioural regulation on body image was examined. The sample (N=732; Year 7 aged 12.23 years and Year 11 aged 16.18 years) included girls in Year 7 (n=489) and in Year 11 (n=243), recruited from 17 metropolitan and 14 rural schools in Victoria, Australia. Girls completed a self-report questionnaire. Novel outcomes from this study revealed year level and region differences in girls' body image perceptions, BMI, and health behaviours. Body dissatisfaction was associated with poorer perceived health, and health behaviours, such as low PA levels and dieting and external PA motivational orientation. Interventions are needed to promote positive body image and intrinsic motivation for PA to increase PA levels among adolescent girls living in metropolitan and rural regions of Australia.