Objectives: In this study, we examined patterns of obesity, physical activity (PA), sleep, and screen time in urban American Indian (AI) youth in the 6th-8th grade. Methods: A youth sample (N = 36) from 3 middle schools was recruited to participate in this observational sample of convenience. Youth completed a demographic and screen time survey, measurements of height and weight, and wore a wrist accelerometer continuously for 7 days to assess PA and sleep. Results: Approximately 42% of participants were overweight or obese. Average weekday screen time was 254.7±98.1 minutes. Compared to weekdays, weekend sedentary activity increased (weekday, 159.2±81.1 minutes vs weekend, 204.3±91.7 minutes; p = .03) and vigorous PA (weekday, 20.9±19.1 minutes vs weekend, 5.7±8.1 minutes; p = .0001) and moderate-to-vigorous PA (weekday, 192.65±62.3 minutes vs weekend, 141±71.7 minutes; p = .002) decreased. Compared to weekdays, weekend total sleep time (weekday, 512.8±48.6 minutes vs weekend, 555.3±84.3 minutes; p = .007) and time in bed (weekday, 487.3±49.6 minutes vs weekend, 528.6±71.2 minutes; p = .01) increased. Conclusions: Weekday to weekend shifts in PA and sleep must be considered when designing targeted obesity prevention interventions.