Families seek advice on their children's weight problems for various reasons. Some children are concerned about their weight and are openly asking for help. Some children are brought by concerned parents but the children, because they are very young or for other reasons, are themselves unconcerned by their overweight. Some parents and children come to the clinic but deny weight is a problem, and the parents are not prepared to talk about the problem in front of their children or pretend they have no concerns about their children's weights. They attend because others – friends, relatives or the school – have told them they ‘must do something about the weight’. Initial approaches to overweight children and their families need to bear in mind these different presentations. Health care practitioners (HCPs) should avoid seeming to criticize parents or to refer automatically to the children as obese since some families are very sensitive to any mention of overweight and, even more, of obesity. Nevertheless, HCPs need to help families develop realistic understanding of the children's overweight and of the need for action.

Once the subject of the child's weight has been broached, first contact with overweight children and their families should focus on the families' expectations from the attendance (Wardle et al. 1995). For some, modifying over-ambitious ideas about what management of overweight can achieve is important.