Overweight during adolescence has social, economic and psychological consequences and low self-esteem is the first detrimental effect observed. Overweight adolescents with low self-esteem are more likely to engage in high-risk behaviors. Besides addiction, another possible explanation for the continuation of smoking by adolescents is the belief that it can help control body weight. The study is aimed to determine the prevalence of overweight and smoking; the association between Body Mass Index (BMI) and smoking; the association between self-esteem and smoking; and comparison of self-esteem between overweight and non-overweight among secondary school students in Kelantan. A cross-sectional study was conducted among 1364 randomly selected Form 2 and Form 4 students in 10 co-educational government secondary schools in Kota Bharu. A survey data analysis was applied. The prevalence of overweight and smoking was 12.5% and 6.7% respectively. There was no association between BMI and smoking; no association between self-esteem and smoking; and no difference in self-esteem between overweight and non- overweight adolescents in Kota Bharu.