Far too many girls suffer from overweight, obesity, and even severe obesity in childhood and adolescence. The early establishment of excess adiposity is associated with the development of cardiovascular disease (CVD) through complex metabolic aberrations that manifest as components of the metabolic syndrome at young ages. When combined with exposure to other independent CVD risk factors, overweight and obese girls face an elevated risk of cardiovascular morbidity and mortality in adulthood. Additionally, due to their reproductive capacity, women face a different series of risks with regards to the development of CVD compared with men. The risk of CVD accumulates across the lifespan of women, and without a special emphasis in terms of prophylaxis and treatment in younger girls and women, their risk of CVD is likely to equal or even surpass that of men in the future.