Pediatric obesity is a common chronic disease with serious long-term health consequences. This narrative review compares current international and national recommendations for the diagnosis and management of pediatric obesity. We focus on guidance from the American Academy of Pediatrics (AAP), the World Health Organization (WHO), the UK National Institute for Health and Care Excellence (NICE), and the Polish pediatric position statement, with reference to other relevant European and expert consensus documents. We also summarize key pathophysiological mechanisms relevant to clinical assessment, diagnostic work-up, and treatment selection. We highlight areas of consensus and clinically important differences, especially in diagnostic thresholds, risk stratification, and screening for obesity-related comorbidities. Across frameworks, family-based lifestyle and behavioral intervention remain fundamental components of care. Pharmacotherapy, particularly glucagon-like peptide-1 (GLP-1) receptor agonists such as liraglutide and semaglutide, and metabolic/bariatric surgery are recommended as adjunctive options for carefully selected adolescents with severe obesity and significant comorbidities. In Poland, published reports and policy analyses suggest that implementation is often constrained by delayed access to specialist obesity services and structured lifestyle-behavioral support, as well as limited reimbursement for anti-obesity medications. As a result, escalation of care may occur late, even among adolescents who meet guideline-based criteria.