Inclusion Criteria:  Parents ≥ 18 years old Children age 5-12 y, with BMI percentile ≥95th for age and sex Child must be enrolled in Missouri Medicaid Parent and child are comfortable speaking English Child is receiving primary care at one of the participating clinics Child lives with the participating parent ≥50% time Child able to provide written or verbal (based on age) informed assent, Child and parent able to participate in scheduled sessions  Exclusion Criteria:  Parent/Caregiver is not the legal guardian of the child Purging (self-induced vomiting, diuretic use, laxative use) as an eating disorder Family lives ≥ 1 hour from the study sites Families planning to move out of the study area during the 12-month study period Child is a ward of the state