“…Compared to children with overweight or obesity, lifestyle approaches and standard behavioral interventions have been shown to be less effective; more intensive treatments are recommended to improve both obesity (e.g., BMI percentile) and health metrics (e.g., blood glucose) (Danielsson, Kowalski, Ekblom, & Marcus, 2012; Johnston et al, 2011). Traditionally, interventions for severe obesity have included intensive family-based treatment (sometimes as an inpatient) (Luca et al, 2015; Taylor, Peterson, Garland, & Hastings, 2016; van der Baan-Slootweg, Benninga, Beelen, et al, 2014), bariatric surgery (Nobili et al, 2015; Schmitt et al, 2016; Thakkar & Michalsky, 2015), medication (Boland, Harris, & Harris, 2015), and/or long-term treatment using a chronic care model (Rijks et al, 2015). Therefore, school-based interventions for children with severe obesity must be coupled with more intensive treatment to lead to clinically meaningful decreases in body measures.…”