Background: Obesity in adolescents is a growing problem which has got its impact on current and future health of populations. The aim of the present study was to assess plasma visfatin levels in obese adolescents. The relationship between serum visfatin and selected anthropometric measurements, insulin resistance (IR) and lipid profile was investigated. Subjects and methods: Anthropometric indices, serum levels of visfatin, fasting insulin, fasting plasma glucose (FPG) and lipid profile were determined in 25 obese adolescents and compared with those in 25 age- and sex-matched non-obese adolescents. Results: The obese group had significantly greater weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist/hip ratio (W/H), serum visfatin, FPG, insulin and homeostasis model assessment (HOMA-IR) values, as well as elevated lipid concentrations except high density lipoprotein (HDL), compared with non-obese adolescents. Serum visfatin correlated positively with WC, BMI, FPG, triglyceride (TG), insulin and HOMA–IR (p <0.05). No correlation was found between serum visfatin and age, sex, serum total cholesterol (TC), low density lipoprotein (LDL) and HDL (p >0.05). Multivariate regression analysis revealed that TG and HOMA-IR were significantly related to visfatin by their order (p = 0.009, 0.014 respectively). Applying receiver operator curve analysis (ROC) in the studied groups showed that 62.1 could be considered a cut off value of visfatin for obesity with specificity (52%) and sensitivity (92%). Conclusions: Our findings highlight a possible relationship between elevated serum visfatin and visceral adiposity and IR in obese adolescents. We suggest that visfatin may be one of the biomarkers related to visceral obesity and IR in obese adolescents. Additionally or alternatively, elevated visfatin levels may represent a compensatory mechanism for IR.