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Background: Body image plays a crucial role in both physical and mental health, influencing self-esteem, eating behaviors, and psychological well-being. Young adults are particularly vulnerable to body dissatisfaction, defined as negative thoughts or feelings about one’s appearance. The benefits of positive body image, characterized by body appreciation and acceptance, are widely recognized, but few digital interventions are designed to support it for young adults.

Objective: We designed a conversational artificial intelligence (AI) agent integrating biomedical information on eating disorders and the principles of cognitive behavioral therapy to enable open-domain conversations on body image. The study explores young adults’ strategies to maintain a positive body image without the agent, the characteristics of conversations with the agent, and the advantages and drawbacks of having a conversation for body image concerns.

Methods: A qualitative study consisting of in-depth interviews with young adults was conducted among 15 young adults (aged 20-30 years) who used the AI agent in their homes for a 1-week period. Data comprise preinterviews exploring young adults’ maintenance of body image without the AI agent, text-based conversations with an AI agent (n=933 messages), and postinterviews on the perceived impact of conversations on body image awareness. Interview transcripts were analyzed through thematic analysis. Content analysis was applied to analyze the conversations with the AI agent.

Results: Young adults’ body image awareness was connected to self-acceptance, confidence, and valuing body functionality. Participants used several strategies to maintain body image without the AI agent, ranging from social support networks to exercise and positive self-talk. The conversations with the AI agent were categorized into (1) body image awareness, (2) body image–related eating and behavioral regulation, (3) body-focused mindfulness, and (4) social conversation with the agent. Three themes of perceived advantages and drawbacks regarding the conversations with the agent were identified as (1) facilitating body image awareness and self-reflection, (2) availability of conversational support, and (3) discontinuities in user engagement.

Conclusions: Young adults’ body image awareness is closely linked to self-acceptance and self-appreciation. In this context, the AI agent was perceived as an available, accessible, and nonjudgmental conversational support in raising body image awareness through self-reflection and self-compassion. Challenges remain in sustaining long-term user engagement, which address the need for multidimensional personalization of the agent.