In this paper we review recent advances in energy metabolism and body composition studies in prepubescent children and the relationship to childhood obesity. Our review on energy expenditure focusses on studies of total energy expenditure using doubly labeled water, the role of energy expenditure in the development of obesity, and the determinants of resting energy expenditure in children. The relatively few studies that have examined the regulation of energy and macronutrient intake in children are also reviewed. In terms of body composition, we focus on recent methodological studies that have developed existing techniques for application to the pediatric population, including dual energy X-ray absorptiometry and bioelectrical resistance. Lastly, we review existing information relating to measurement and alteration of body fat distribution in children.