Background: Children and adolescents with severe and/or genetic obesity require continuous care and long-term treatment due to the chronic, relapsing, and progressive nature of their disease. Understanding the molecular mechanisms underlying the regulation of hunger, satiety, body weight, and the development of obesity enables a personalized treatment approach. Individualized, multimodal treatment strategies are essential for effective, long-term management of severe and/or genetic obesity in affected children and adolescents. New pharmacological treatments, such as mechanism-based medications for genetic obesity and incretin-based drugs for severe obesity, represent significant advances in chronic weight management and are valuable adjuncts to individualized lifestyle interventions. Summary: This article outlines an innovative, structured care and treatment concept for children and adolescents with severe and/or genetic obesity tailored to their specific needs and requirements. It emphasizes the importance of providing care within specialized treatment centers under the “Chronic Care Model,” in close collaboration with local healthcare providers. Key Message: In order to ensure long-term treatment of children and adolescents with severe and/or genetic obesity, innovative and structured care concepts consisting of individualized, multimodal treatment strategies in specialized treatment centers in collaboration with local healthcare providers are required.

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