There is very little data to help guide clinicians, despite probable similarities in clinical care and lived experiences that affect gender diverse youth with obesity. There is a complex relationship between weight and body habitus, gender identity and expression that could influence engagement in weight management and attrition within structured programs. Based on the high prevalence of victimization and marginalization, treatment goals should consider the negative impact of these social-related complications. Moreover, gender-affirming hormone therapies may worsen obesity, change body composition, or increase cardiovascular risk. Careful attention to barriers to care as well as medical and behavioral comorbidities can inform care to better support clinicians, patients and gender diverse youth with obesity.