We describe the characteristics of adolescents seeking treatment for obesity via the ‘Eat Smart’ feasibility study; an intensive 12 week dietitian‐led weight management programme with an emphasis on lifestyle change. It was designed to test the feasibility of a structured low‐fat diet compared with a semi‐structured reduced carbohydrate plan compared with a model of ‘standard care’– an unstructured low fat approach. When compared with non‐participants, participants were predominantly female and lived in lower socioeconomic areas. When given the choice of dietary approach, 50% elected reduced dietary carbohydrate, 43% structured low fat and 7% chose ‘standard care’. Modest weight loss was achieved over 12 weeks, with both the structured low fat and reduced carbohydrate formats. Families showed a strong preference for structured eating plans, in particular seeking assistance with correct portion size. The current standard model of unstructured advice was both unpopular and relatively unsuccessful.