In the past two to three decades, several hundred randomized controlled trials (RCTs) have been conducted to prevent overweight and obesity among children. Meta-results show that overall previous interventions have yielded small but positive results. While public health initiatives designed to prevent obesity in children and adolescents should aim to reduce health inequalities, the overall effectiveness of these efforts still remain uncertain. Also, with one notable exception, all previous RCTs included mixed groups where 20-30% of participating children were already overweight or obese alongside those with a healthy weight. This presentation will discuss how initial weight status and health inequalities influence the success of interventions aimed at preventing childhood overweight and discuss ways to improve the future successes in childhood obesity lifestyle interventions.