Recent data indicate a rise in obesity both in children and adolescents in developing countries. The overall prevalence of overweight/obesity in urban children in New Delhi has shown an increase from 16% in 2002 to about 24% in 2006-2007. Our recent data show that the prevalence among adolescent children was 29% in private schools and 11.3% in government funded schools. While India already has highest number of patients with type 2 diabetes mellitus (T2DM) globally, rapid rise of obesity in children is the prime reason for increasing insulin resistance, the metabolic syndrome, dyslipidemia, polycystic ovarian syndrome and raised levels of C-reactive protein. Excess body fat, thick truncal subcutaneous fat, and abdominal adiposity are important predisposing factors for development of insulin resistance in Asian Indian children. As compared to other ethnic groups, children with ancestral origin in South Asia manifest adiposity, insulin resistance and metabolic perturbations earlier in life and these derangements are of higher magnitude than white Caucasian children. Since the metabolic syndrome and obesity track into adulthood, these clinical entities need to be recognized early for effective prevention of T2DM and coronary heart disease. Therapeutic lifestyle changes, maintenance of high levels of physical activity and normal weight are most important prevention strategies. Both high-risk surveillance and cost-effective population intervention programs are urgently needed. In this context, we have launched one of the largest program ("MARG", The Path) to curb childhood obesity in India.