The high prevalence of obesity in the United States threatens to reverse the trend of decades of health improvement. If we are going to stem the tide of the obesity epidemic, we need answers to several key questions: How can we most effectively draw on the 2 main strategies used in disease prevention, a clinical strategy targeting those at high risk and a broad environmental strategy that targets entire communities? What should be the goal of interventions for those who are already overweight or obese—achieving clinically significant weight loss or avoiding additional weight gain? We will also need to consider how to best serve our diverse population. Sadly, some communities face a disproportionate burden of obesity. Obesity is particularly common among some racial and ethnic minority populations, including 59% of African American women.1 Can interventions be developed that are acceptable, accessible, affordable, and effective in the socioeconomically disadvantaged populations at highest risk for obesity and consequent health problems?