Effective child obesity interventions remain frustratingly elusive. Obesity continues to affect 1 in 5 children with disproportionate impacts on non-Hispanic Black and Hispanic children.1 In this issue of Pediatrics, Resnicow et al describe the results of a promising multisite randomized controlled trial of a primary care-based, motivational interviewing intervention.2 The multicomponent intervention resulted in a greater increase in BMI percent 95 (BMI percent 95 is the percentage of the 95th percentile and used for tracking change among those with obesity) for intervention children versus children receiving usual care. These findings reflect the complexity of treating obesity in “real-world settings.”