The prevalence of obesity in children and adolescents as reported by the United States Centers for Disease Control and Prevention and the World Health Organization ranges from 20% to 30%. The effects of overweight and obesity on the structure and function of the muscles, connective tissue, and joints are well documented in published biomedical literature. An understanding of the effects of obesity on the growing musculoskeletal system is of special significance for appropriate management of associated conditions. Altered biomechanics and neuromuscular control are recognized as a key contributor to obesity-related musculoskeletal sports injuries and other musculoskeletal concerns in children and adolescents. A relatively higher incidence of sports-related lower extremity musculoskeletal injuries is reported among obese children and adolescents. Other musculoskeletal concerns in obese children and adolescents include an increased incidence of specific conditions (Blount disease, kyphosis, slipped capital femoral epiphysis), increased risks for fractures of extremities and spine, difficulties with anesthesia and airway management, difficulties with management of musculoskeletal trauma, increased post-operative risks, and a higher prevalence of musculoskeletal pain.