Purpose: This paper aims to provide a summary of current policy and research related to pre-school overweight and obesity, and to provide a rationale for why early years settings are being placed at the forefront of strategies to address the problem. Design/methodology/approach: The paper is based on a narrative review of current research, policy and practice. Findings: Today 22.9 per cent of four and five year olds are overweight or obese. The Healthy Weight, Healthy Lives strategy is a cross-government initiative, which aims to make England the first major country to reverse the obesity epidemic. The pre-school period represents a critical time for interventions, which could prevent excess weight gain and its associated physical and psychological damage to health. Practical implications: Practitioners in early years settings have a significant contribution to make to promoting the healthy weight of children. Originality/value: Concerns about overweight in childhood have received much attention. This paper seeks to raise awareness of the importance of the pre-school period, and to provide a useful review of current research, policy and sources of support for those who are best placed to address the issue.