Aim: To determine the role of hepatic artery resistive index (HARI) measurement in the prediction of insulin resistance (IR) in obese children with nonalcoholic fatty liver disease (NAFLD). Materials and methods: A total of 64 obese subjects with NAFLD (13.5 ± 1.36 years of age, 34 male) and 32 age-and gender-matched control subjects (13.8 ± 1.24 years of age, 16 male) were enrolled in the study. All subjects underwent a physical examination, laboratory tests, and ultrasonographic and Doppler examinations of the liver. The homeostasis model assessment of IR (HOMA-IR) was used for the IR diagnosis. Results: Obese subjects with NAFLD had significantly higher HARI, insulin, alanine aminotransferase (ALT), total cholesterol (TC), triglycerides (TG), and HOMA-IR than the control subjects. Obese subjects with NAFLD and IR had significantly higher HARI compared to obese subjects with NAFLD but without IR (0.761 ± 0.04 vs. 0.732 ± 0.04, P = 0.006). Changes in HARI correlated significantly to changes in BMI, SDS-BMI, MAC, TSF, MAC, ALT, TC, insulin, and HOMA-IR (r = 0.578, P = 0.001; r = 0.547, P = 0.001; r = 0.549, P = 0.001; r = 0.504, P = 0.001; r = 0.549, P = 0.001; r = 0.223, P = 0.029; r = 0.306, P = 0.002; r = 0.315, P = 0.011; r = 0.295, P = 0.018, respectively). As an optimal cutoff point, a HARI level of 0.715 determined IR with 81.2% sensitivity and 71.9% specificity. Conclusion: Our findings suggest that HARI might be used as a simple and non-invasive screening method to predict IR in obese children with NAFLD. © TÜBİTAK.