As a consequence of the global rise in the prevalence of Adolescent Obesity, an unprecedented phenomenon of Type 2 Diabetes (T2D) has emerged in pediatrics. At the heart of T2D development lies a key metabolic derangement: Insulin Resistance (IR) . Despite the widespread occurrence of IR affecting an unmeasurable number of youths worldwide, its pathogenesis remains elusive. IR in obese youth is a complex phenomenon that defies explanation by a single pathway. In this review we first describe recent data on the prevalence, severity, and racial/ethnic differences in Pediatric Obesity.