There is increasing public awareness of the rising incidence of obesity in childhood and adolescence, and its consequences for long-term health – type 2 diabetes, cardiovascular disease and cancer. This year’s symposium meeting focused on epidemiology, management and mechanisms of obesity. The trends in obesity in children and adolescence, at both a global and national level were reviewed. The UK House of Commons Select Committee’s report on obesity suggests that obesity ‘will soon surpass smoking as the greatest cause of premature loss of life’. If we can understand the cause we can potentially make an impact on future healthcare. The review covered primary prevention, early intervention and management of the significantly obese. People want to understand why they are overweight and what impact obesity will have on their health. Rare monogenic causes of severe obesity give insight into central mechanisms underlying weight control. Hormones are intrinsically linked with obesity, but do not provide the easy solution hoped for by many. A discussion around three case studies concluded the symposium.