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Becky Cohn has worried about her daughter's weight since she was a toddler. Molly would eat "anything and everything," her mother says. "She would eat salads, but she would want three salads. She would eat broccoli but want seconds." The child was completely unlike her older siblings that way — and once she hit school age, Mom felt powerless to control the problem. "She'd go to school and eat her lunch and everyone else's," Cohn says. "I went to the pediatrician and said, 'I feel like I'm watching my daughter drown.'" Molly was nevertheless physically active and had no social problems with other kids. But by age 10 — at 4 ft. 11 in. and 134 lb. — she was already heavier than her mother and clinically obese.

It's one of the hardest talks a doctor can have with a family: how to deal with an overweight kid. By all accounts, it's equally frustrating for pediatrician and parent — a battle that plays out in doctors' offices across the U.S. "My doctor, whom I love and have a lot of respect for, kept saying the same things," Cohn says. He would ask what on earth she had been feeding her daughter and suggest that Molly needed to exercise more and eat less. The Cohns never found that rote advice specific enough to be useful.

For their part, doctors say families as concerned as the Cohns are unusual. Most parents have a woeful lack of knowledge about basic nutrition. Doctors tell stories about patients who feed French fries and Cheetos to their children before their first birthday, for example. What's worse is that many families with overweight or obese children aren't even aware there is a problem.

In 2007 a national poll from C.S. Mott Children's Hospital at the University of Michigan asked parents to report their oldest child's weight and height and then gauge whether he or she was a healthy size. "About 40% of parents of obese children ages 6 to 11 perceived their children's weight status to be 'about the right weight,'" says Matthew Davis, the University of Michigan pediatrician who directed the poll. A further 8% believed their child was actually underweight. "It's almost as if parents don't know what obese looks like in that school-age group," Davis says.

That may be precisely the problem. Today roughly 17% of American kids and teens are obese, and parents cite obesity as a top concern for their children's health. Yet with so many other overweight kids in the class, it appears that parents can't recognize — or admit it to themselves — when their child is too heavy. When they do realize it, like Becky Cohn, parents often are upset or don't know how to implement pediatricians' vague orders about exercise and diet — much the way overweight adults are flummoxed by the same recommendations.

Adding to the quandary, doctors may be reluctant to raise the issue in the first place. Checkups are typically too brief to allow a doctor to broach the topic tactfully and work out a detailed, practical weight-loss plan. Some doctors fear they will worsen the problem by embarrassing the child and instilling shame instead of empowering him or her to get healthy. And doctors worry about turning off Mom and Dad as well. "Every parent feels guilty that their child has a weight problem," says David Ludwig, the director of the Optimal Weight for Life Program at Children's Hospital Boston and the author of the kids'-weight-management book Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World. Kids aren't the ones buying family groceries, after all, and parents often struggle with being overweight themselves.

But Ludwig reminds parents they are not solely to blame for their child's weight. Many other environmental influences — from fatty school lunches to fast-food ads — are simply outside parents' control. That doesn't mean they can't make a difference at home, though, by getting junk food out of the cupboards, limiting TV time and — most important — being good role models. "The tragedy that so often occurs is that parents, out of fear for their kids' health, make a bad situation worse by using coercive parenting practices," Ludwig says. In his book, Ludwig writes that forcing certain dieting rules or other behaviors upon kids, especially when parents don't live up to their own standards, rarely motivates kids to take responsibility for their habits. Coercion can also fray family ties and undermine the child's self-esteem.

Ludwig gives parents tips on how to work with their kids, not against them, by reinforcing good habits instead of punishing bad ones. He tells pediatricians to relay a "message of hope" when they talk to families with overweight children. Obesity is not destiny, and in fact, because kids are still growing, they may have an easier time getting back to a healthy weight than adults do. "Most of the time, we're not talking about kids losing weight. Most of the time, we're talking about kids maintaining their weight while their height catches up," says Michigan's Davis.

What's clear is that childhood obesity cannot be solved in a single doctor's visit. Ludwig sometimes spends several sessions with a patient at his Boston clinic before coming up with a concrete plan — and persuading the child to cooperate. "Many children come in at first unwilling to talk about the problem. They feel so embarrassed," Ludwig says. But when change comes, it can make a huge difference. "With just the smallest tangible results, a sense of empowerment can grow," Ludwig says. "The child may go from denying a problem exists and fighting their parents' efforts tooth and nail to joining in and working together."

As for Becky Cohn, last year she decided she had to try something different. Diets hadn't worked, and she wanted Molly — soon to enter the fifth grade — to be able to make good decisions on her own. In June, mother and daughter left their home in Birmingham, Ala., and traveled to Camp Shane, a weight-loss camp for kids age 7 and older in New York's Catskill Mountains. There, in an idyllic rural setting, kids like Molly try out new sports and activities and learn about calories, how to read food labels and, of course, the importance of eating three balanced, portion-controlled meals a day. Cohn came along as staff, the "Camp Mom." "There's nothing easy about it, confronting [a weight problem], getting over the stigma of being here," she says. But after five weeks of the camp's regimen — approved by doctors — Molly has lost almost 15 lb. The girl smiles. "I think when I get home," Molly says, "I'll eat in moderation."

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• Laura Blue