Nonalcoholic fatty liver disease (NAFLD) is an obesity-associated liver disease found in 3% to 9% of children in the United States. NAFLD represents a spectrum of liver disease and is frequently associated with features of the metabolic syndrome. Nutrition's role in NAFLD is complex. It does not appear that overweight children with NAFLD have an unusual diet compared with their overweight counterparts without NAFLD. It is more likely that they have increased genetic susceptibility to the general poor diet and state of positive calorie balance currently found in many children. The available treatment studies using nutrition counseling and increased physical activity are promising. We recommend initiating sustainable family-oriented lifestyle changes in all children with NAFLD.