Overweight is an increasingly prevalent pediatric health problem but is underdiagnosed. Despite recommendations endorsing the use of body mass index (BMI) to identify overweight children, clinicians seldom use BMI. Barriers to the use of BMI in pediatric primary care have not previously been described. We used qualitative data to determine providers' familiarity with and attitudes toward recommendations for identifying overweight children and the perceived barriers and facilitators to use of BMI.