Obesity is characterized by an excess accumulation of adipose tissue, independent of its distribution or function, and is associated with organ dysfunction and a broad range of metabolic and cardiac complications. Nutritional, environmental, behavioral, genetic, psychological, and metabolic factors contribute to obesity. It is associated with many secondary complications, including diabetes mellitus, hypertension, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, reduced quality of life, and psychological illnesses. For practical purposes, childhood obesity can be classified into polygenic, monogenic, syndromic, and endocrine causes. Management should be patient-centered and multidisciplinary, integrating lifestyle/behavioral changes with adjunctive pharmacotherapy and bariatric surgery where appropriate. In monogenic or syndromic obesity, knowing the underlying genetic etiology allows precision-guided and more effective therapy. This review aims to provide a state-of-the-art review on the management of obesity in children.