The prevalence and severity of child and adolescent overweight (OW) in the United States have been documented, but little is known regarding the prevalence of OW and "Extent of Overweight" (EOW) in individual states or specific regions within states. The aim of this study was to determine the prevalence of OW and EOW in school-aged youths from 4 regions of Georgia. A 2-stage cluster sampling procedure was performed in 2002, with participation of 4th-, 8th-and 11th-grade students (N = 3114). Measured height and weight were used to determine body mass index (BMI) for age percentiles and data were weighted to estimate population prevalence of OW. A logistic regression model determined predictors of OW. The overall estimate of OW prevalence was 20.2% and highest in males (22.0%), non-Hispanic blacks (21.8%), "other races" (32.4%), and students residing in rural growth (23.7%) and rural decline (23.0%) areas. Overweight prevalence was similar among grades. The overall estimated EOW was 4.3 and highest in males (4.7), other races (5.6), non-Hispanic blacks (5.2), and students from rural growth (5.4) and rural decline (5.0) areas. Sex, race, location, and economic tier were significant predictors (= 0.02) of OW. The prevalence and severity of OW was higher in youths residing in Georgia than nationally. School health professionals, community leaders, and parents should provide support for updated school policies aimed at providing BMI surveillance and a school environment that encourages physical activity and healthy nutrition practices.