Childhood obesity is of great concern in the USA and worldwide due its health consequences. BMI percentiles still remains the best tool available, and once at-risk youth are identified, pediatric providers are asked to engage families to make specific changes. We will review the role of obesity prevention in health promotion for youth through the framework of the social ecological model. First, individual choices are and should be discussed, and patient-centered communication is a useful tool in engaging parents and children. The role of parents and schools on the development of negative and positive habits that contribute to weight gain in youth is elucidated, as well as the importance of having a supportive neighborhood and community. National and local policies also influence the types of choices that children and their parents can make and have a wide impact that will be highlighted. To promote better health for children and assisting children in making healthier choices will be paramount.