BACKGROUND: Practice guidelines recommend all children with obesity are connected with comprehensive health behavior and lifestyle treatments (CHBLTs) as a first-line intervention. OBJECTIVE: To understand primary care providers' (PCPs) current practices, resources, barriers, and needs related to providing or referring children with obesity to CHBLTs. DESIGN AND METHODS: For this cross-sectional study, 62 PCPs from a multi-site healthcare system in the Midwest, USA, completed an online survey to report the following: which interventions they offer, referral options they have available inside and outside their practice, barriers to providing CHBLTs, and resources they want related to CHBLTs. RESULTS: The most common practices included sharing body mass index with families and brief lifestyle counseling. Few PCPs reported access to CHBLTs in their clinic or in the community despite rating these services as highly important. Top barriers included lack of services, perceived family motivation, and time. PCPs desired referral options and training in motivational strategies. CONCLUSIONS: Implementation of best practices for pediatric obesity treatment will require expanded availability of CHBLTs and development of effective patient engagement approaches. PRACTICE IMPLICATIONS: The competencies of pediatric nurses may be particularly well suited to addressing care gaps for pediatric obesity in primary care settings.