Pediatric obesity is a growing global health problem. Arab children are among the world`s ten heaviest children. The causes of childhood obesity are complex and multifactorial. Assessment of an obese child includes history, thorough examination and investigations for the cause and comorbidities. Abdominal obesity is the predictor of other components of metabolic syndrome regardless the body mass index (BMI). Components of metabolic syndrome run in vicious circles. Obesity- induced inflammation and insulin resistance press the button of other components of metabolic syndrome. Beta cell dysfunction passes through phases of stressed beta cells with insulin resistance and prediabetes followed by failing beta cells and type 2 diabetes. Screening for type 2 diabetes is indicated in children aged 10 years and more with BMI above 85th percentile for age with risk factors. Glucolipotoxicity exacerbates beta cell loss and dysfunction causing type 2 diabetes. Non alcoholic fatty liver disease (NAFLD) is a common comorbidity associating obesity initiated by oxidative stress and inflammatory cytokine release that could end by liver cirrhosis. Polycystic ovary syndrome (PCOS) is a complex interaction between genes and environment leading to excess hepato-visceral fat causing hyperandrogenism and insulin resistance. Healthy life style is the cornerstone of treatment of PCOS. Obesity is only the tip of the iceberg. Therefore, screening for obesity comorbidities is important.