Childhood obesity has tripled over the past 30 years, and the most recent CDC data shows 19.7% of children and adolescents, and 12.7% of 2-5 year olds have obesity. Early and rapid weight gain tracks into later childhood, adolescence, and adulthood and leads to worse health outcomes. Rates are higher in low-income children. Achieving long-lasting treatment results for childhood obesity with lifestyle modification is difficult once BMI crosses the 95th percentile. Obesity is increasingly recognized as a chronic disease with increased occurrence of serious health consequences, including but not limited to, diabetes, hypertension, heart disease, fatty liver disease, sleep apnea, joint problems, anxiety, and depression. Therefore the focus is shifting to obesity prevention with healthy eating and active living in pregnancy, infancy, and childhood to alter adiposity and weight gain trajectories. Children with risk factors need earlier and aggressive preventive measures.