Although research published during the past year suggests the prevalence of childhood obesity in the USA may have plateaued, it remains unacceptably high and places large numbers of youths at elevated risk of chronic diseases. The concept of the metabolic syndrome (MetS) is frequently used to help capture this increased risk. Use of the MetS concept with children remains controversial, however. Addressing issues related to the definition of the MetS and its utility in clinical and research settings has generated a variety of recent investigative efforts. At the same time, the past year revealed a number of promising prevention and treatment interventions for childhood obesity and the MetS. Still unknown, however, is the optimal combination of diet, exercise, and other behavioral changes for improving the obesity and MetS status of children. These issues are the subject of this review.