As regular physical activity of high enough intensity is essential in the management of overweight, efforts should be made to increase physical activity adherence in overweight children. To make overweight children exercise and follow the recommendations, it is essential to have insight into determinants of exercise initiation and adherence. According to the Self-determination Theory, creating opportunities to satisfy the need for autonomy (i.e., having choices), competence (i.e., feeling effective) and relatedness (i.e., being socially connected) might increase autonomous motivation for physical activity in overweight children and promote a long-lasting active lifestyle. To increase feelings of autonomy in overweight children, exercise programs could be delivered in an autonomy-supportive manner by providing choices, supporting the child's initiatives, avoiding use of external rewards, offering relevant information and rationale for changing behaviour, making a decisional balance and using autonomy supportive language, while minimizing pressure and control. Perceived competence in physical activities could be increased by offering activities tailored to the capabilities of the overweight child, helping the children set realistic goals, learning the children self-management skills, providing the children with appropriate feedback and organizing separate exercise sessions for overweight children. Feelings of relatedness in overweight children might increase by adopting an empathic approach, showing interest in the child's well-being and problems, showing enjoyment and enthusiasm, knowing the names of the children, talking to the children as equals, offering group sessions and talks, encouraging club participation and having a sports partner and encouraging parental support.