The key to helping an obese child lose weight is not to shame them, a child paediatrician says.
In fact, it is best not to even mention obesity or weight loss and focus instead on "healthy lifestyle change".
That is the approach of Whanau Pakari, a Taranaki-based programme which was launched in 2012.
"Many people still have this assumption that children and families have got into this situation by sitting on the couch and eating junk food," said Yvonne Anderson, a paediatrician at the University of Auckland's Liggins Institute.
"And that's simply not the case. The judgmental, stigmatising process of fat-shaming has to stop. Life in Aotearoa for many is really complex now. Lots of factors are at play, such as food security, juggling work and childcare and time commitments.
"If we just focus on weight we are missing the point."
Whanau Pakari completely "demedicalises" weight loss, removing it from the hospital and focusing instead on the child's home life and family.
And because of the complex factors which lead to obesity, the programme has multiple disciplines. Each child is assessed for general health, diet, exercise and mental health. They then get weekly sessions with a fitness coach, a nutritionist and a psychologist.
Anton Madden, from New Plymouth, enrolled his son Zachary in the programme last year. Aged 7 at the time, Zachary was 56kg.
"It was really hard to motivate him to be active, to get away from the computer or Xbox," said Anton, who is a solo dad. "It was a real fight just to go for a walk or get him to ride his bike."
Through Whanau Pakari, the family was taught to cook in the local school and were given "virtual supermarket tours" which taught them how to buy healthy food on a budget and read food packaging labels.
"We learned that if we are going to buy mince we get the more expensive, premium brands which has less fat in it," Anton said. "And just basically include a whole lot more vegetables. We make our own cooking sauces from scratch now, rather than ones in jars because those have heaps of salt and fat in."
After six months, Zachary had lost 5kg. More importantly, his habits had changed. He ate child portions and he biked to school every day. He cut down on his screen time.
"I changed my lifestyle too," Anton said. "Anyone who wants to do it can. It's about breaking bad habits and sticking with the new habits."
Natalie Baker, a mother of four from Stratford, enrolled her 10-year-old daughter Breeze in Whanau Pakari this year. After six months, her weight has fallen from 67kg to 60kg.
They were a sporty family but their diet was poor, with large amounts of takeaways, fizzy drink and large portion sizes.
"We've learned that we don't need to eat as much if we're eating the right things," Baker said. "We add beans to the meals, and lentils. We've changed from white bread to multi-grain, which is more filling."
She said the key to Breeze's healthier lifestyle was involving the whole family.
"We didn't have to make her feel like it was just her in the wrong. We explained to the whole family that we would be participating once a week, and learn new things and activities and cooking. They were happy as."
Whanau Pakari is an intensive programme, and the drop-out rate is relatively high.
For those who attend at least 70 per cent of the weekly sessions, there have been some promising signs. Their cardiovascular fitness and quality of life improves, and they have a modest reduction in body mass index. For about a quarter of children on a high-intensity version of the programme, they lose enough weight to move into a "normal" weight range.
"There are stories of inspiration, of making the rep hockey team when they were struggling with hip pain, or managing to get into a rugby team that they had been trying for ages, or completing the Weetbix triathlon," Anderson said. "Those are the stories that keep us going."