Overweight kids often have self-esteem issues, particularly if they're victims of taunting or bullying at school. It bears repeating, yet again, that working on weight is about ensuring your child's physical and psychological well-being, not about being pretty or popular. Integrating healthy lifestyle habits into your child's daily life should take priority over the numbers on the scale. Putting undue emphasis on losing weight sends the message that losing weight is the most important aspect of your child's life, and it ties your child's value to his physical size.

It's hard to fight years of cultural conditioning about fat and obesity. Even with the best and most supportive parental efforts, children can sometimes hang on to a negative self-image. When you don't seem to be making headway with your child, and he appears depressed, disheartened, or anxious about his fitness efforts or life in general, a qualified therapist or counselor can be invaluable.

When a Therapist Can Help

For children with self-esteem issues, cognitive-behavioral therapy (or CBT) may be helpful. A therapist will work with your child to expose those faulty or irrational thought patterns (referred to as automatic thoughts) that are at the root of her poor self-image. A process called validity testing is used to expose automatic thoughts by requiring the child to defend those thoughts with facts and logic.

For example, a therapist might ask a child who ties his self-worth to his weight to come up with a list of things he is good at, such as playing the piano or excelling in math. Then the therapist might ask him to list the thin peers he knows and what they seem to be good, and not so good, at. Odds are that in a few of the areas where your child excels, his peers can't compete, and vice versa. These facts show that he does indeed have value, that value is not size-dependent. All kids have different strengths and weaknesses, but that doesn't make yours any less valuable as a person.

CBT also works on changing behavior patterns so your child has better coping strategies at her disposal. If she previously ran for the refrigerator every time a peer teased her, the therapist might model some different ways your child could react instead, or the two might role-play through the situation. Other common tools in CBT include daily journaling and cognitive rehearsal, in which a child mentally rehearses how to handle teasing so his response is automatic when the situation arises.

Beyond cognitive-behavioral therapy, individual therapy may also focus on other aspects of skill-building or personal insight. A therapist might teach your child stress management and/or relaxation techniques to cope with anxiety. She might also use play with younger children to uncover the issues bothering your child and to allow your child to express herself in a more accessible way.

Family Therapy

Sometimes your child's individual therapist or counselor may suggest a few sessions of family therapy. This is a way of making sure everyone understands your child's needs and is committed to working together to support him. Family therapy can also be useful if there's discord or disagreement among family members and it's interfering with your child's weight loss efforts. Sometimes a neutral third party can be invaluable in providing a candid view of the family dynamics at work along with constructive suggestions on how to improve relationships among siblings or between parents and children.

To make family therapy most effective, everyone must commit to attending a minimum number of sessions and to trying the counselor's suggestions as the sessions progress, whatever those suggestions may be. Make sure this promise is made before the first session even begins — odds are that at least one family member is not going to agree with the counselor's take on things.