In New York City (NYC), 43% of elementary school children are at an unhealthy weight; more than half of these children are obese. This is a much larger proportion than expected based on the national rate. In our public high schools, 28% of the students are either overweight or obese . Overweight children have many risks, including hyperlipidemia, hypertension, type 2 diabetes, social stigmatization, and psychosocial difficulties. Providers should monitor weight status and consistently offer counseling on healthy eating and exercise to all children and adolescents, even those who are at a healthy weight.