It is estimated that as many as 25% of children and 30% of adults in the United States are obese. Clinicians need little reminding of the intractable nature of this disorder and the need for more effective and long-lasting therapies, Obesity in childhood may lay the foundation of the degenerative cardiovascular diseases that may or may not be grossly evident until adulthood. Obese children manifest many of the same disturbances (eg, hyperinsulism, hyperlipidemia, and hypertension) as obese adults. Tracking studies of obesity, hypertension, and serum lipid values from childhood to adulthood have indicated that these variables track well, ie, that the obese, hypertensive, hyperlipidemic child is likely to remain obese, hypertensive, and hyperlipidemic throughout many years. The observation that hyperlipidemia, obesity, and other factors associated with an increased risk of subsequent cardiovascular disease that are noted in childhood tend to persist into adulthood emphasizes the importance of screening in selected children to identify those at risk for subsequent morbidity. Pediatricians should recognize obesity as a significant disease entity with both immediate and long-term consequences.