The incidence of obesity and overweight has almost doubled in Western societies over the last 2 decades, a trend mirrored in developing nations transitioning to first-world economies. Obesity is strongly associated with the comorbidities of type 2 diabetes, hypertension, and heart disease and represents an enormous burden to health care systems. Of even more concern is the increase of around 40% in the prevalence of childhood obesity and type 2 diabetes over the last 20 years. Metabolic disease results from complex interactions of many factors, including genetic, physiologic, behavioral, and environmental influences. The recent rate at which these diseases have increased suggests that environmental, eg, epigenetic, and behavioral influences, rather than genetic causes, are fuelling the present epidemic. In this context, the developmental origins of health and disease hypothesis has highlighted the link between periconceptual, fetal, and early infant phases of life and the subsequent development of adult obesity and related metabolic disorders. Both maternal undernutrition (global and targeted) and maternal obesity elicit an obese offspring phenotype. This review will examine the role of altered maternal nutrition on obesity risk in offspring, the interactions with the postnatal nutritional environment, the possible strategies for intervention, and the role of epigenetics in the disease process.