Children and adolescents with obesity have a serious, chronic, and relapsing disease that alters adult heath and requires lifelong strategies. Multicomponent lifestyle interventions are one of the essential lifelong strategies, but they are hard to implement specially during adolescence. There is increasing evidence on the beneficial effects of newer obesity medications such as glucagon peptide like receptor agonist alone or in combination but there is limited long term data on its use and there are access issues at present. Most of these medications cause gastrointestinal side effects. Children with severe early onset obesity and hyperphagia caused by single gene abnormalities (leptin, proopiomelanocortin and proprotein convertase subtilisin/kexin type 1) can potentially be managed with new medications such as setmelanotide already approved in United States and Europe. Short to medium term studies of bariatric surgery including many adolescents have shown a significant and sustained improvements in body mass index and obesity comorbidities. Long term studies of bariatric surgery (8 years) are very limited. They are no studies evaluating transition to adult care of adolescents with obesity.