According to the Centers for Disease Control and Prevention, childhood obesity in the United States has tripled in the past 30 years to the point that more than one-third of children and adolescents in 2008 were overweight or obese.1,2 Obese adolescents are more likely than their normal-weight counterparts to have risk factors for cardiovascular disease3 and to be obese as adults,4 and more than one-third of all adults in 2008 were obese.2 A study by Vivante et al5 in this issue of the Archives adds the development of end-stage renal disease (ESRD) to the list of adverse outcomes associated with adolescent overweight and obesity. Previous studies6,7 have described a relationship between obesity and ESRD among adults, but the study by Vivante et al is unique in its population-based design, with universal, mandatory screening of all 17-year-old residents before military service. Because urinalysis and a thorough medical history were obtained from all the participants and because those with proteinuria, hematuria, or a diagnosis related to kidney disease were excluded from the study, preexisting subclinical disease was effectively ruled out as the source of the association between overweight and obesity and subsequent ESRD. Nevertheless, Vivante et al reported a 3-fold higher risk for incident ESRD during approximately 25 follow-up years for overweight adolescents and an almost 7-fold higher risk for obese youth.