The prevalence of overweight in youth has increased three- to four-fold in the United States since the 1960s. The school environment can play prominently in the mitigation of this epidemic by increasing physical activity opportunities/ levels, decreasing the availability of food/ beverage with added sugar, and enhancing students' scientific understandings about energy balance. The potential to increase energy expenditure goes beyond the school day to include safe routes for walking and biking to school (active transport) as well as the availability of school facilities as a community resource for physical activity outside of school hours. However, school consolidation and siting decisions have profound effects on active transport as well as the school as a community resource. Teachers and adolescents should not be overlooked as important partners in conceiving and carrying out programming that seeks to increase physical activity levels in youth and the broader community. As leaders and health care providers in their communities, physicians are postured to be effective advocates of, and to leverage in their own practice, school-based policies and practices towards promoting healthy weight in youth.