BACKGROUND: Weight bias internalization (WBI) negatively effects health outcomes in people with obesity. Little is known about how these experiences relate to quality of life and vary in racially/ethnically diverse adolescents with severe obesity. Associations between WBI and health-related quality of life (HRQOL) by race/ethnicity among a sample of adolescents seeking metabolic and bariatric surgery (MBS) were examined in this analysis. METHODS: In this single-site cross-sectional study of adolescents seeking MBS (NCT05393570, March 2022 to October 2024), WBI was measured using the 11-item weight bias internalization scale and HRQOL by the standardized HRQOL scale. Race/ethnic group differences were evaluated by univariate/multivariable linear regression analysis. Multivariable regression models were adjusted for age, sex, body mass index, and race/ethnicity. RESULTS: The final sample consisted of 76 adolescents (mean age 15.7 [SD 1.4] years, mean BMI 44.7 kg/m CONCLUSION: WBI was inversely associated with feeling healthy among racially/ethnically diverse adolescents seeking MBS. Adolescent MBS programs may consider screening and targeting WBI to optimize health outcomes.