Abstract The increasing prevalence of overweight youth in the United States and the associated increase in medical comorbidities has created a growing need for effective weight-management interventions. The recommended treatment for an overweight child to achieve a more healthful weight uses four primary behavioral strategies: (a) reduce energy intake while maintaining optimal nutrient intake to protect growth and development, (b) increase energy expenditure by promoting more physical movement and less sedentary activity, (c) actively engage parents and primary caretakers as agents of change, and (d) facilitate a supportive family environment. Although this approach has the most empirical support, the impact on the pediatric obesity epidemic has been limited, particularly for adolescents with more severe obesity and for African-American, Native-American, and Hispanic children. This has prompted efforts to adapt strategies that have been effective in adult weight management for use in pediatric behavioral intervention programs. These include using motivational interviewing to increase readiness for health behavior changes, modifying the carbohydrate content of children’s diets, using culturally appropriate messages and materials, improving cultural competency of health care providers, and using computer-based strategies. Randomized, controlled clinical trials are needed to test the safety and efficacy of these approaches before they can be recommended for clinical practice. Pharmacotherapy and bariatric surgery are more aggressive and historically adult interventions with greater risk that are being considered for severely obese adolescents who have serious obesity-related medical complications and who have failed other more conventional methods.