Background: Increased visceral or abdominal adipose tissue in children and adults is strongly associated with metabolic and a variety of chronic diseases. Aim: to study the association between visceral or external body measurements of adiposity with blood lipids, glucose and insulin levels, in obese female adolescents. Material and methods: In a cross-sectional study, 47 obese female adolescents (body mass index (BMI) > 95th percentile) aged 10 to 15 years, were analyzed. Weight, height, BMI, Tanner pubertal stages, skinfold thickness, waist circumference, waist-to-hip ratio, fasting and 120 min post prandial blood glucose, serum insulin, and lipid profile were studied. Visceral fat was assessed by computed tomography at the 1.4-1.5 level, measuring the fat area of the length of a straight drawn line between the spine and the interval border of the rectus abdominus muscle. Results: No association between lipid profile and BMI or external body measurements (skinfold thickness, waist circumference, waist-to-hip ratio) was observed. Total serum cholesterol > 170 mg/dL was positively associated with the straight line over 63 mm (a cut-off obtained by ROC analysis (RR 2.64; 1.15-6.08). This association was statistically significant in girls in Tanner I + II (n = 21; Fisher, p < 0.023), but not with Tanner III + IV (n = 26) stages. Increased cholesterol (< 170 mg/dL) was also positively associated with a serum insulin > 16 uU/mL in the Tanner I + II group (fisher p < 0.05). but not with the homeostasis model assessment of insulin resistance (HOMA). Conclusions: No external body measurement of adiposity was associated to increased serum cholesterol. in these obese female adolescents. Increased total cholesterol (> 170 mg/dL) was associated with visceral fat (evaluated through the straight line spina-rectus abdominus muscle), and also with a serum insulin > 17 uU/ml in those teenagers with Tanner I or II pubertal stages.