Objective <p>This study investigated the dynamic developmental association between weight self-stigma and exercise adherence among obese adolescents. A three-wave longitudinal survey was conducted on 665 obese adolescents through random-intercept cross-lagged analysis.</p> Methods <p>The Weight Self-Stigma Scale and the Exercise Adherence Scale were utilized to perform a half-year, three-stage follow-up questionnaire investigation on 665 obese adolescents from two junior high schools, two senior high schools, and one vocational secondary school.</p> Results <p>At the inter-individual level, a significant negative correlation was found between weight self-stigma and exercise adherence in adolescents. At the intra-individual level, the levels of weight self-stigma and exercise adherence in adolescents remained relatively stable at adjacent time points, and both exhibited a certain degree of stable development over time. In the random-intercept cross-lagged model, weight self-stigma and exercise adherence had a reciprocal negative predictive relationship. Moreover, further multi-group comparisons revealed that the causal relationship between weight self-stigma and exercise adherence was consistent across genders.</p> Conclusion <p>These research findings offer a scientific foundation for devising intervention strategies aimed at addressing weight self-stigma and exercise adherence issues among obese adolescents, which is of great significance for the health management of obese adolescents, thereby facilitating the promotion of the physical and mental health development of adolescents.</p>