Body weight dissatisfaction (BWD) among adolescents may be a predictor of adoption of health-risk behaviors. The study aimed to assess the gendered association between two forms of BWD (feeling underweight/overweight) and cardiovascular health-risk behaviors among Brazilian adolescents. This cross-sectional study used data from the National Study of Cardiovascular Risks in Adolescents (ERICA) in Brazil, including 71,740 adolescents aged 12–17 years. BWD was defined as satisfied, dissatisfied feeling underweight and dissatisfied feeling overweight. We considered four health-risk behaviors: tobacco use, alcohol use, physical inactivity and skipping breakfast. Assessment of the associations between BWD and these behaviors were undertaken using logistic regression models. All analyses were stratified by gender. Analyses revealed that 14.9% of male adolescents and 14.5% of female adolescents were dissatisfied feeling underweight and 21.5% of males and 39.9% of females were dissatisfied feeling overweight. Among male adolescents, dissatisfied feeling overweight was associated with greater odds of physical inactivity and skipping breakfast. Among female adolescents, dissatisfied feeling underweight and overweight were associated with higher odds of alcohol use and skipping breakfast. These results highlight the importance of BWD and the association with a range of adolescent health behaviors increasing cardiovascular risk over the life course, depending on gender.