Counseling by health care professionals represents a potentially important intervention for the prevention and treatment of pediatric obesity. One promising approach to weight-control counseling in pediatric practice is motivational interviewing. This article explores conceptual issues related to the application of motivational interviewing for the prevention and treatment of pediatric obesity. Given the paucity of studies on motivational interviewing and pediatric obesity, we examine what is known about the application of motivational interviewing to modify diet, physical activity, and other behaviors in children and adolescents. We begin with a brief overview of motivational interviewing, describe some nuances of applying this approach to pediatric overweight, and conclude with research and clinical recommendations.