Rates of childhood obesity have risen dramatically in the past decades. Currently, 31.6% of children are overweight or obese. Obesity is associated with significant medical complications, including a significant effect on the musculoskeletal system. Recent research is reviewed, describing the effect of obesity on the growth plate and developing skeleton, alterations in risk for fractures and other musculoskeletal disorders, and alterations in treatment or outcomes in orthopaedic surgery. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.