Obesity among children has reached epidemic proportions. Today, an estimated one in four children in the United States is overweight. while 11% arc obese. Children who are overweight tend to remain so up to 20 years of age; in general, they have a 1.5- to twofold higher risk for becoming overweight as adults. The prevalence of overweight has increased approximately twofold in the 20-year period from 1974 to 1994, with the largest increases observed among 19- to 24-year-olds. The annual increases in weight and obesity that occurred from 1983 to 1994 were 50% higher than those from 1973 to 1982. Overweight youth are 2.4 times as likely to have a high serum total cholesterol level, and 43.5 times as likely to have three cardiovascular risk factors. Although the total energy intake of children has remained the same, and the macronutrient density of the diet has changed, the percentage of energy from fat has decreased, while that from carbohydrates and protein has increased. Children have been consuming lower amounts of fats/oils, vegetables/soups, breads/grains, mixed meats, desserts, candy, and eggs. and increasing amounts of fruits/fruit juices, beverages. poultry, snacks, condiments, and cheese. Changes in specific eating patterns may explain the increase in adiposity among children; e.g., increases have occurred in the number of meals eaten at restaurants, food availability, portion sizes, snacking and meal-skipping. Successful prevention and treatment of obesity in childhood could reduce the adult incidence of cardiovascular disease. Because substantial weight loss is difficult to maintain, the prevention of obesity by promoting healthier lifestyles should be one of our highest priorities in the new millennium.