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Purpose: This study aims to explore the mediating effect of the health self-efficacy and activity confidence in the relationship between body image and health promoting behavior in middle school girls. Methods: A descriptive correlational design was used. Participants were 142 in middle school girls. The questionnaire consisted of measuring tools for body image, health promoting behavior, health self-efficacy and activity confidence. The collected data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation coefficient and the PROCESS Macro for SPSS 23.0 to verify the multiple mediated effect with a parallel structure. Results: Body image showed a significant positive correlation with health self-efficacy (r=.28, p=.001), activity confidence (r=.45, p<.001) and health promoting behavior (r=.37, p<.001). Health self-efficacy was also significantly correlated with activity confidence (r=.51, p<.001) and health promoting behavior (r=.63, p<.001). Activity confidence was significantly health promoting behavior (r=.67, p<.001). Furthermore, health self-efficacy (B=.35, p<.001) and activity confidence (B=.38, p<.001) showed a mediation effect on the relationship between body image and health promoting behavior. Conclusion: The impact of body image on health promoting behavior in middle school girls was mediated by health self-efficacy and activity confidence. Result suggest that strategies for improving health self-efficacy and activity confidence in middle school girls should be considered when developing an educational program for enhancing their health promoting behavior.