Weight management is a game of chance for most children and young people, and is dependent on service availability and the expertise of the provider. Many localities are without established weight-management services, and the effectiveness of those provided is often not well-known.

SHINE (Self Help, Independence, Nutrition and Exercise) is the only documented tier 3 community-based service provider in the UK. It offers a plethora of interventions tailored to each child or young person using a stepped-care approach (SCA) to treat severe obesity: as the severity of obesity increases, so does the intensity of intervention.

This article describes an SCA and uses this model to demonstrate a range of appropriate, available interventions. A SCA can provide a holistic and integrative care pathway for children and young people with severe obesity when implemented at tier 3.