Aims. To study the influence of low-intensity solution-focused family therapy with obese and extremely obese pediatric subjects on body mass index (BMI) z-scores and self-esteem. Materials and Methods. Fifty-four obese children, aged 6-17 years, were referred to an outpatient obesity clinic. The families received solution-focused family therapy provided by a multidisciplinary team. Height and weight were recorded; BMI and BMI z-scores were derived. Self-esteem was assessed with a validated questionnaire, "I Think I Am." Parents completed "The Family Climate Scale" assessing family dynamics. Results. Eighty-one percent of the children (n=44, mean age 11.9 years, mean BMI z-score 3.67, range 2.46-5.48) and their parents participated in the follow-up. Eleven children were treated for 6-12 months, and 33 for more than 12 months. On average, the families received 3.8 family therapy sessions. Intervention resulted in a mean decrease in BMI z-score of 0.12 (p=0.0001). Self-esteem on the global scale improved after intervention (p=0.002), and also on sub-scales, depicting physical characteristics (p<0.001), psychological well-being (p=0.026), and relations with others (p=0.046). The Family Climate Scale showed improvement in the sub-scales for Expressiveness (p=0.002) and Chaos (p=0.002). Conclusions. Solution-focused family therapy provided by a multidisciplinary team to obese and extremely obese children may prove useful in the clinical setting, with a positive impact on obesity and self-esteem.