Objective To examine the associations of peer victimization with internalizing symptoms, externalizing symptoms, social competence, and academic performance in a clinical sample of adolescents with severe obesity, and whether self-worth and social support affect these associations. Methods Multisite cross-sectional data from 139 adolescents before weight loss surgery (Mage = 16.9; 79.9% female, 66.2% White; MBody Mass Index [BMI] = 51.5 kg/m2) and 83 nonsurgical comparisons (Mage = 16.1; 81.9% female, 54.2% White; MBMI = 46.9 kg/m2) were collected using self-reports with standardized measures. Results As a group, participants did not report high levels of victimization. Self-worth mediated the effects of victimization on a majority of measures of adjustment, and further analyses provided evidence of the buffering effect of social support for some mediational models. Conclusions Self-worth and social support are important targets for prevention and intervention for both victimization and poor adjustment in adolescent severe obesity.