Background: Diverse environmental factors are associated with physical activity (PA) and healthy eating (HE) among youth. However, no study has created a comprehensive obesogenic environment index for children that can be applied at a large geographic scale. The purpose of this study was to describe the development of a childhood obesogenic environment index (COEI) at the county level across the United States. Methods: A comprehensive search of review articles (n = 20) and input from experts (n = 12) were used to identify community-level variables associated with youth PA, HE, or overweight/obesity for potential inclusion in the index. Based on strength of associations in the literature, expert ratings, expertise of team members, and data source availability, 10 key variables were identifiedsix related to HE (# per 1000 residents for grocery/superstores, farmers markets, fast food restaurants, full-service restaurants, and convenience stores; as well as percentage of births at baby (breastfeeding)-friendly facilities) and four related to PA (percentage of population living close to exercise opportunities, percentage of population < 1 mile from a school, a composite walkability index, and number of violent crimes per 1000 residents). Data for each variable for all counties in the U.S. (n = 3142) were collected from publicly available sources. For each variable, all counties were ranked and assigned percentiles ranging from 0 to 100. Positive environmental variables (e.g., grocery stores, exercise opportunities) were reverse scored such that higher values for all variables indicated a more obesogenic environment. Finally, for each county, a total obesogenic environment index score was generated by calculating the average percentile for all 10 variables.