Contraceptive counselling in adolescence is challenging. Based on the preexisting knowledge of girls and young women about various contraceptive methods, which are often uncritically presented to adolescents by modern media, the counselling situation has become more complex in recent years. Detailed questions about the methods and a critical evaluation of the side effects, especially of hormonal contraceptives, are typical for the counselling. The decision on contraception in risk situations as obesity is an additional challenge in adolescence. International recommendations on contraception consider adolescence and obesity, but up to now, there are no recommendations for combining both situations. This article aims to provide guidance for the counselling and decision-making process on contraception for obesity in adolescence. Basically, the effective hormonal contraceptives with hormonal combination pills or vaginal ring and intrauterine devices without and with hormonal release are preferable. Long-term and trust-based care in the gynecological practice is important for girls and young women with obesity to motivate weight management and reduce secondary diseases.