Obesity is reaching epidemic proportions in the USA and is a growing problem in developed countries. It is associated with a number of co-morbidities, such as coronary artery disease, type 2 diabetes, gall bladder disease and sleep apnoea. The health care cost associated with obesity in US adults is estimated to be 100 billion dollars annually.1 Trends in childhood obesity are paralleling those of adult obesity, with ~25% of American children either overweight or obese.2 Childhood obesity is associated with increased risk factors, such as high cholesterol and hypertension, for chronic illness in adulthood, and with increased presentation of co-morbidities, such as type 2 diabetes, in early adolescence.3,4 These trends in childhood obesity are global, with increasing prevalence in Russia, China and Brazil, as well as the USA. Wang suggests that this trend will lead to a rise in global rates of obesity-related diseases.1 Data from the US National Health and Nutrition Examination Surveys reveal that the prevalence of adult and childhood obesity increased substantially over a single decade. This increase cannot, therefore, be attributed to changes in the genetic makeup of the population. The rapid rate of increase in the prevalence of obesity must be due to the interaction between genetic predispositions and changes in the environment, such as decreased opportunities for physical activity and increased availability of calorically dense foods.5 Such trends speak to the need for family-based behavioural weight management programmes, since families share genetic predispositions, as well as environments. This article reviews the current literature, specifically examining family-based treatment programmes, types of dietary interventions and macronutrient issues. Epstein laid the groundwork for family-based behavioural treatments with his landmark 1990 publication in which he compares 10-year follow-up data on three family treatment programmes. Golan and colleagues continue work in this area. They examine not only changes in children’s weight resulting from family-based behavioural programmes focused on children’s weight loss, but also changes in parents’ weight and cardiovascular risk factors. Lastly, Spieth and colleagues explore the hotly debated topic of dietary macronutrient content and glycaemic index in the context of behavioural change programmes. This article concludes with recommendations for family physicians in their work with obese children and their families.