In simple terms control of overweight and obesity requires a sustained period of energy expenditure exceeding energy intake. Overweight individuals' dietary intakes and activity levels have to change. However, overweight and obesity arise because energy balance has been influenced by the environment – family and community – in which the obese live. Without changes in these environments, weight control is unlikely to be sustained for long. Thus, almost inevitably, successful weight control involves behavioural changes for the family as well as for the overweight child. Further, since evidence suggests that ‘healthier’ lifestyles can reduce morbidity risks for the overweight/obese even without significant change in weight status, the prime aim of management should be to develop healthier behaviours. Appropriate weight controlling strategies can then be incorporated into these (Avenell et al. 2006).

If we consider programmes which aim to control overweight and obesity in children, some are impressively successful. Others are not. Overall, obesity management programmes have a reputation for disappointing outcomes. The fault may not always lie in the programme itself but in the way in which it is implemented (or not implemented).

Table 8.1 suggests some reasons why well-planned schemes may appear to have little effect on childhood overweight. There is no consensus on how or where overweight and obesity in childhood (or even in adult life) should be managed (Chapter 3).