Background. Hispanics are disproportionately affected by the obesity epidemic in the United States. Obesity is a primary risk factor for the development of cardiovascular disease (CVD) and Type 2 diabetes, which are problematic in Hispanic adults. There are limited data relating obesity status in Hispanic adolescents to diabetes and CVD risk. Methods. We studied 115 lean and obese adolescents (89 Hispanic, 26 Caucasian), ranging in body mass index (BMI) from 15 to 52 kg/m2. We assessed the relationships between four anthropometric indices of obesity and risk factors for Type 2 diabetes (insulin (INS), glucose (GLU)), and CVD (total cholesterol, triglycerides, HDL, and systolic (SBP) and diastolic (DBP) blood pressure). Results. All anthropometric indices were positively correlated with total cholesterol, triglycerides, log(INS), GLU, SBP, and DBP, and negatively correlated with HDL. Correlations and multiple regression analyses indicated that weight and waist circumference (WC) were generally the best single predictors of disease risk. Using more than one anthropometric measure in multiple regression did not improve predictions of risk over using a single predictor. Conclusions. These results indicate that overweight adolescents (particularly Hispanics) are at risk for developing Type 2 diabetes and CVD, and that WC and weight are useful for identifying those at particular risk. © 2003 American Health Foundation and Elsevier Inc. All rights reserved.