Metabolic syndrome is a constellation of interrelated risk factors of metabolic origin that often accompany obesity and consist of atherogenic dyslipidemia, elevated blood pressure, impaired glucose tolerance, a prothrombotic state, and a proinflammatory state. Using a modification of the criteria by the National Cholesterol Education Program Adult Treatment Panel III, metabolic syndrome in children and adolescents can be clinically diagnosed when three or more of the following are present: body mass index ≥ 2 z score, systolic or diastolic blood pressure greater than 95th percentile, triglyceride level greater than 95th percentile, and/or high-density lipoprotein cholesterol less than 5th percentile and impaired glucose tolerance (fasting glucose > 110 mg/dL [6.1 mmol/L]). The prevalence of the metabolic syndrome in adolescents has been shown to be 4% overall, but it is 30% to 50% in overweight adolescents. In the United States, 18% to 22% of children and adolescents are overweight; the prevalence of a metabolic syndrome phenotype among US adolescents has also been increasing significantly over the past decade. All of the features of metabolic syndrome are risk factors for atherosclerosis, and metabolic syndrome has been shown to constitute risk for atherosclerotic cardiovascular disease in adults. In children and adolescents with metabolic syndrome, biomarkers of an increased risk of adverse cardiovascular outcomes are already present. Therefore, there is need for prevention and treatment of metabolic syndrome in this population. The mainstay of the treatment is dietary intervention and promotion of active lifestyle to achieve and maintain optimum weight, normal blood pressure, and normal lipid profile for the height and age. The pharmaceutical intervention is usually not required and its long-term outcome has not been studied. There is need for large studies for the management and long-term outcomes of metabolic syndrome in children and adolescents if the future tides of cardiovascular and other associated complications of metabolic syndrome are to be turned around.