Objective To describe baseline characteristics of participants in a pediatric obesity intervention tailored specifically to rural families delivered via telemedicine. Methods Randomized-control trial comparing a family-based behavioral intervention to a usual care condition. Participants Fifty-eight first through fifth graders and their parents from the rural Midwest. Measures Demographic, body mass index (BMI), Actigraph activity monitor information, 24-h dietary recalls, Child Behavior Checklist, Behavioral Pediatrics Feeding Assessment Scale. Results Child mean BMI was in the 94th percentile for weight. Average daily dietary intake exceeded 2,000 kcal and children consumed over eight servings of high-calorie, low-nutrient-dense foods. Children are engaged in approximately 65 min of moderate, 12 min of vigorous and over 300 min of sedentary physical activity daily. Conclusions Baseline data suggest children in rural areas may engage in adequate physical activity but eat many daily servings of energy-dense foods. Rural families may benefit from a comprehensive, rurally tailored obesity-related health behavior intervention.