This 18-month prospective study investigated factors that contributed to changes in eating disorder symptoms among adolescents living in the People's Republic of China. Five hundred forty-one Chinese middle school and high school students (182 boys, 359 girls) completed measures of eating disorder symptoms; body dissatisfaction; appearance ideal endorsements; negative affect; and appearance-based social pressure, teasing, and comparison. For girls, baseline levels of negative affect, preference for a thin appearance ideal, and fatness concern made unique contributions to reported eating disturbances at the 18-month follow-up. For boys, baseline body mass index and fatness concerns were the only significant univariate predictors of changes in eating pathology. (Contains 5 tables.)