Zeller MH, Kidwell KM, Reiter‐Purtill J, et al. - Researchers conducted the study for monitoring conventional cigarette smoking behaviors and associated correlates in adolescents with severe obesity who did or did not undergo metabolic and bariatric surgery to 4 years after surgery/baseline. Using a prospective controlled design, surgical (n = 153; mean BMI = 52) and nonsurgical (n = 70; mean BMI = 47) groups that completed assessments before surgery/at baseline and at Years 2 and 4 post surgery (Year 4: n = 117 surgical [mean BMI = 38]; n = 56 nonsurgical [mean BMI = 48]) have been compared. According to findings, more than half of candidates (surgical: 55%; nonsurgical: 60%) had ever smoked a cigarette, with current smoking increasing with time. Dysregulation, internalizing symptoms, alcohol use, caregiver smoking, friend smoking, and perceiving low harm, plus greater percent weight loss in the surgical group, were factors correlated with higher Year 4 current smoking probabilities. For adolescents and young adults with severe obesity, particularly those who have undergone metabolic and bariatric surgery, smoking is a clinical health challenge. Priority should be given to upstream detection, tracking, and intervention to avoid smoking uptake and escalation across settings in young people with obesity.