Background: Obesity prevalence among children and adolescents has dramatically increased in the past decade and has resulted in higher rates of type 2 diabetes mellitus (T2DM) among adolescents. Purpose: To examine whether there are gender differences in T2DM risk perception, attitude toward T2DM protective behaviors, physical activity, and meeting the recommended fruit and vegetable daily intake among adolescents at risk for T2DM. Methods: Overweight and obese students were included in this study (n = 319). Linear regression analyses were used for all models. Analyses were carried out using SPSS (Ver 20.0). Gender differences in the regression models were considered statistically significant at P < 0.05. Results: Females showed significantly higher positive attitudes toward eating healthy foods such as fruits and vegetables (B = 9.089, ß = 0.337, P = 0.000). Females were more likely to consume more cups of fruit and vegetables than males (B = 1.650, ß = 0.118, P = 0.036) and more likely to use calorie information when ordering/buying food compared to males (B = 0.765, ß = 0.245, P = 0.000). However, males were more likely to engage in moderate physical activity (PA; B = -22.076, ß = -0.110, P = 0.050) and vigorous PA (B = -45.145, ß = -0.235, P = 0.000) compared to females). Conclusion: To effectively develop health promotion initiatives for students/adolescents, it is important to examine gender differences and factors that influence them. Translation to Health Education Practice: Findings from this study suggest the need for Health Education Specialists to consider gender variations when developing and evaluating T2DM prevention health programs for youth.