This study examined the relationship between cigarette smoking and body perception across measured body weight among adolescents aged 12–19 years, using 2005–2014 National Health and Nutrition Examination Survey data. Adjustment showed that normal weight girls who perceived themselves as overweight had a significantly higher smoking prevalence ratio of 2.03 (95% confidence interval (CI): 1.22–3.40). The prevalence of cigarette smoking and weight misperceptions among adolescent girls indicates a need for topics addressing body perception and body image among students to be included in smoking prevention programs in schools. In addition, factors that shape adolescent girls’ perception of body weight should be examined.