To treat the obese child or the child who is becoming obese appropriately, the clinician must determine if the adiposity is temporary or the beginning of a permanent trend that requires intervention. The concept of the "adiposity rebound" helps with this decision. The child's family is important and contributes to his or her body adiposity through both nature--an inherited metabolic tendency towards obesity--and nurture--the eating and activity environment and the family functioning. The activity level and energy intake, which although out of balance for the obese child, may not be low or excessive when compared to recommended amounts for children of that age or to that of peers. A child-family pattern can be defined in overweight children based on presence of a metabolic tendency, energy intake, activity level, and family functioning. In looking at the pattern rather than just the child's weight, the clinician can be much more effective with a weight control program, and with proper referral for changing family functioning prior to such a program if necessary.