BACKGROUND: A number of research studies have demonstrated a decrease in health-related quality of life (HRQL) measures among obese children. Moreover, the causes of HRQL impairments are not completely clear. Adolescent obesity is oftentimes associated with other cardiometabolic risk factors (CRFs); hence, the aim of our research was to estimate the frequency of CRFs and to determine whether there is an association between CRFs and HRQL scores among obese adolescents. METHODS: Our research included 92 treatment-seeking obese adolescents (11-17 years), 34 males. We looked at medical records and performed physical examinations, including anthropometry and laboratory evaluations. PedsQL™ 4.0 was used to assess the HRQL score. Logistic regression models were used to identify CRFs associated with worse HRQL scores, both in total and in each domain. RESULTS: The vast majority (70.6%) of adolescents had at least one CRF in addition to obesity. A cluster of three to four CRFs was found in 23.3% and was associated with males more than with the degree of obesity [odds ratio (OR) 4; confidence interval (95% CI) 1.3-11.6, p = 0.01]. HRQL scores in emotional functioning domain and scores of HRQL total were directly associated with waist circumference Z-score (OR 4.1; 95% CI 1.1-14.9, p = 0.03 and OR 3.4; 95% CI 1-11.6, p = 0.049). Hypertension was associated with worsening HRQL scores in school functioning domain (OR 3.3; 95% CI 1-10.9, p = 0.049). CONCLUSION: Obesity in adolescents is associated with a high frequency of associated CRFs and decreased HRQL scores. Although CRFs have an influence on reducing adolescents' HRQL, they are not a determining factor.