The purpose of this observational study was to examine the prevalence of obesity in children of 6 to 8 years of age from primary public schools over a period of 6 years and the associated environmental and metabolic health risk factors.This was a cohort observational study to investigate the prevalence of obesity in children from 14 state primary schools in Vinhedo, Sao Paulo state. Environmental and metabolic health risk factors for obesity were investigated in a cross-sectional survey.This present study revealed 74.0% of children with obesity consumed fried foods and sweets at school, and 84.0% consumed snacks and soft drinks at home. This cohort reported to have engaged in physical activity for less than 3 hours per week at school (93.0%) and at home (85.0%). There was a high prevalence of increased waist circumference and insulin resistance among children with obesity (84.9% and 84.5%, respectively). The body mass index had a significant Spearman correlation with waist circumference, insulin resistance, and triglycerides.Childhood obesity was associated with a high prevalence of both environmental and metabolic risk factors. Also, the authors conclude that the lack of parents' awareness of childhood obesity and its risk factors represents a substantial barrier to lifestyle counseling.