Body image is a tenuous and variable construct. Among adolescents, a rapidly changing body and malleable sense of self compound this flexibility. For the adolescent with Inflammatory Bowel Disease (IBD), we must consider body image and self-identity in light of delayed development, Cushingoid features, dramatic fluctuations in weight, surgical scars, and the poignancy of pediatric chronic illness. To articulate and better describe body image and identity, we conducted a pilot study designed to facilitate discussion and illustrate concepts of self, body satisfaction, and understanding of illness in a group of adolescents with IBD. We conducted semi-structured interviews with 11 adolescents with Crohn's disease, ulcerative colitis, or indeterminate colitis. Each adolescent told his or her “story”, a self-derived narrative describing concepts that the adolescent deemed important. Following the interview, each teen completed two interactive questionnaires. Each interview was transcribed, coded, and analyzed by the researcher. Among our 11 adolescents interviewed, all had prior corticosteroid exposure, 6 were maintained on an immunomodulator (6MP/MTX), 3 were maintained on biologics (infliximab, adalimumab), 8 had previous hospitalizations and 3 had prior surgical procedures. BMI ranged from 17.2 (2nd percentile) to 28 (96th percentile). 8/11 adolescent patients agreed with the statement, “My own body is my ideal body”. Every teen (11/11) expressed either positive or neutral sentiment about the ideality of their body. When asked to identify which features describe the ideal body, our teens most frequently responded with attributes that pertained to their size. When adolescents were asked to label these features as a facet of the body's aesthetic appearance or its functionality, adolescents preferentially chose function. Teens focused their interview discussion on the salience of the unique IBD experience itself. When asked to choose a graphic illustration meant to convey the degree to which ‘IBD’ overlapped with ‘self’, adolescents chose a wide range of responses, ranging from no overlap to almost complete absorption of illness into self. These adolescents with IBD expressed an exceptional (and unexpected) positivity of body image - adolescents with objectively severe disease declared their own body as ideal. In reshaping and redefining their concept of ideal, adolescents alter the focus of body image, rendering it sensitive to their physical functionality rather than appearance. ‘Tall’ becomes ideal not because it is beautiful or masculine, but rather because, for this particular patient population, it is indicative of health. For the clinician, this research suggests that the most salient factor, that which drives body image itself, is the subjective experience of the patient, an entity that exists independently of the patient's objective clinical status. When emphasizing that a patient “looks great!”, the physician reinforces the notion that appearance exists as a derivative of health itself - care should be taken here to underscore that a healthy body is one defined by it's functionality, irrespective of physical appearance. Clinical providers should acknowledge the unique experience of IBD and yet emphasize that while it is intrinsically influential, it should not be defining.