The relationship between childhood obesity and aspects of the built environment characterizing neighborhood social context is understudied. This study evaluates the association between 7 built environment domains and childhood obesity in Durham, North Carolina. Measures of housing damage, property disorder, vacancy, nuisances, and territoriality were constructed using data from a 2008 community assessment. Renter-occupied housing and crime measures were developed from public databases. The authors linked these measures to 2008-2009 Duke University Medical Center pediatric preventive care visits. Age- and sex-specific body mass index percentiles were used to classify children as normal weight (>5th and ≤85th percentile), overweight (>85th and ≤95th percentile), or obese (>95th percentile). Ordinal logistic regression models with cluster-corrected standard errors evaluated the association between weight status and the built environment. Adjusting for child-level socioeconomic characteristics, nuisances and crime were associated with childhood overweight/obesity (P < .05). Built environment characteristics appear important to childhood weight status in Durham, North Carolina.