Inclusion Criteria:  child is age 2 through 18 years at referral child's BMI meets or exceeds the 85th percentile for age and sex parent can read and respond to interviews and questionnaires in English or Spanish received care at one of the participating pilot sites  Exclusion Criteria:  children who do not have at least one parent who can report on their child's daily activities for 1 year families who plan to leave their pediatric health center in the next year children who have conditions or take medications that substantially interfere with growth, physical activity, or dietary recommendations