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Barriers and facilitators of pediatric weight management among diverse families. OBJECTIVE: To describe barriers and facilitators relevant to pediatric weight management from the perspective of at-risk overweight children and families. METHODS: Systematic thematic analysis of semistructured interviews with overweight children and families from diverse backgrounds at a large, urban academic pediatrics practice. RESULTS: Twenty-five parents and their children ages 2 to 18 years with mean body mass index percentile of 96th% (standard deviation 4.3) participated. Fifty-six percent were Black; 40% were Hispanic/Other race. Perceived barriers to successful weight management included (a) inadequate resources (financial, time, access to programming, knowledge), (b) challenging social contexts (cultural practices and expectations, interpersonal dynamics), (c) negative emotional state (lack of confidence, defeat, loneliness), and (d) denial. Participants described linkages to resources, child-parent--provider partnerships, and consistent support as key elements in successful weight management. Participants also endorsed technology use for weight management support. CONCLUSIONS: Multiple barriers and facilitators affect weight management among at-risk families, which should be considered in future obesity interventions.