Approximately 1 in 5 U.S. children and adolescents have obesity, disproportionately affecting children of color and those with lower socioeconomic backgrounds. Lack of access to healthy foods, increased sedentary lifestyles and genetic predispositions all play a role in this growing epidemic. Obesity at a young age has a direct impact on longevity and not to mention, the cost of healthcare over a lifetime, with medical costs for children with obesity at $116 higher per person per year compared to children with a healthy weight. Lifestyle and behavioral interventions, while often effective, are not always feasible for all children due to social determinants. So what about bariatric surgery or the ever-effective GLP-1s? And how do we ensure this heightened focus on weight will not lead to disordered eating as children grow? There are no clear-cut solutions, but many are working tirelessly to find the perfect balance of care for children in need.