O besity is an intensifying public health problem worldwide. In the United States, approximately two-thirds of adults and nearly one-third of children are either overweight or obese by government standards.1,2 The National Institutes of Health standards for overweight and obesity for adults are based on body mass index (BMI). Because BMI is a less reliable measure of overweight/obesity in growing children than in adults, both the International Obesity Task Force and the Centers for Disease Control (CDC) favor using gender-and age-based percentiles of BMI as measures of childhood overweight and obesity.3 Thus, in this report, we use the term "overweight" to refer to children with an age-and gender-based BMI at or above the 85th percentile but below the 95th percentile. The term "obese" describes children ABSTRACT BACKGROUND: Childhood obesity is an intensifying public health problem that affects millions of U.S. children. Obesity leads to the development of health conditions such as hypertension, diabetes, gastroesophogeal reflux disease, depression, and hypercholesterolemia. The increasing prevalence of these conditions among U.S. children is reflected in increased use of medical services and medications in both childhood and adulthood. Pre-intervention and post-intervention surveys were administered to a convenience sample of 6,421 students at 49 participating schools. Attitudes were measured using a 6-point Likert-type graphic face scale (smiles positive, frowns negative) and analyzed for statistical significance of pre-intervention to post-intervention change using paired t-tests. RESULTS: After exposure to the Shape It Up program, children reported higher levels of knowledge (P < 0.001) and positive attitudes (P < 0.001) about healthy eating and exercise compared with the baseline survey results. In a question to gauge satisfaction with the program, 54.9% of children surveyed gave the program the highest possible rating, and overall, 91.7% selected 1 of the 3 response categories toward the positive end of the 6-point scale.CONCLUSION: Shape It Up appears to have had a positive impact on children's knowledge and attitudes toward exercise and healthy eating. Additional research employing a comparison group is needed to assess the program's impact. • Data from the most recent National Health and Nutrition Examination Survey (NHANES 2003(NHANES -2006 indicate that 16.3% of children and adolescents between the ages of 2 and 19 years old were obese (body mass index at or above the 95th percentile) and 31.9% of children were overweight (body mass index at or above the 85th percentile).• Obesity, in turn, increases the risk for the development of several health conditions and diseases, including hypertension, diabetes, gastroesophogeal reflux disease, depression, and hypercholesterolemia.