Overweight in adolescence is considered an important predictor of long-term morbidity and mortality. The impact of adolescent overweight on adult overweight and related multiple cardiovascular risk factors was examined in a biracial (black-white) cohort (N = 783) who participated in two cross-sectional surveys as adolescents aged 13 to 17 years and as young adults aged 27 to 31 years. The cohort was categorized as adolescent-onset adult overweight (N = 110) or lean (N = 81) according to age-, race-, and sex-specific body mass index (BMI) greater than the 75th percentile or between the 25th and 50th percentiles on both surveys. The risk for overweight adolescents to remain overweight as young adults ranged from 52% in black males to 62% in black females. As young adults, the overweight cohort showed adverse levels of body fatness measures, systolic and diastolic blood pressure, lipoprotein cholesterol, insulin, and glucose as compared with the lean cohort (P < .01 to P < .0001). The prevalence of clinically recognized hypertension and dyslipidemia increased 8.5-fold and 3.1- to 8.3-fold, respectively, in the overweight cohort versus the lean cohort (P < .05 to P < .0001). The prevalence of parental history of diabetes mellitus and hypertension increased 2.4-fold (P < .01) and 1.3-fold (P < .05), respectively, in the overweight cohort. Clustering of adverse values (> 75th percentile) for the total cholesterol to high-density lipoprotein (HDL) cholesterol ratio, insulin level, and systolic blood pressure occurred only among the overweight cohort (P < .0001). Thus, excess weight in adolescence persists into young adulthood, and has a strong adverse impact on multiple cardiovascular risk factors, requiring primary prevention early in life.