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The current review focuses on the importance of primary prevention of obesity in youth. In several elementary school programs such as Texas I-Can and the Physical Activity Across the Curriculum initiatives, physical activities are integrated into the academic lessons to help offset sedentary time during seated learning while also increasing academic performance. The purpose of such programs is to attenuate gains in body mass index and adiposity while increasing physical activity levels. In some cases, increases in physical activity were translated to after-school and weekend activities. In other cases,  improvements in time on task and academic courses were also observed. In schools monitoring BMI, those increasing physical activity levels > 75 min/wk evidenced significant decreases in BMI.   At the middle school level, programs such as Planet Health and another novel middle school curriculum in the sciences, resulted in beneficial changes in health behaviors and metabolic risk factors. These changes were accompanied by decreases in adiposity, particularly in girls.  In the most recent translational health in nutrition and kinesiology (THINK) program, a stand-alone curriculum featuring hands-on clinical experiences rooted in STEM education, resulted in significant gains in physical fitness and curricular-based knowledge with favorable but non-significant decreases in adiposity. These studies illustrate the importance of implementing innovative programs that may increase academic performance while also empowering students to increase physical activity and improve metabolic health, both of which are often accompanied by favorable reductions in adiposity.  Physically active interventions that are integrated into the academic curriculum may be the best direction to take in the primary prevention of obesity. More randomized clinical trials are needed to determine the extent to which such active interventions significantly reduce adiposity in youth.