These complex physiologic and pathophysiologic relationships make the determination of vascular health more difficult, especially in children and adolescents. In this issue of the Journal, Charakida et al. (13) report on the results from the ALSPAC (Avon Longitudinal Study of Parents and Children). They evaluated children age 10 to 11 years who had been followed since birth and found that overweight and obese children had higher heart rates and systolic blood pressures compared with children of normal weight. They also found that obese children had greater brachial artery diameter, as well as greater resting and hyperemic blood flow and lower arterial stiffness, compared with children of normal weight. These vascular findings may at first seem reassuring or even favorable. However, the combination of increased cardiac output, a higher heart rate, and higher blood pressure may be more ominous for future findings in the cardiovascular system in these children. The vascular system appears to be adapting to the early obesity-related hemodynamic changes. However, in the context of the anticipated large number of aortic and vascular expansions and stretching expected over a lifetime, the known relationships of these hemodynamic factors to vascular structural and functional changes, and the concomitant changes in insulin resistance, inflammation, and other vasoactive factors associated with obesity, these results suggest that these young subjects are on a path toward increasing vascular stiffness, increasing blood pressure, and concentric left ventricular hypertrophy as they grow into adulthood.