Childhood obesity has increased dramatically during the past two decades. The growing incidence of childhood obesity is alarming, given the significant short- and long-term health consequences associated with obesity and the strong tracking of obesity from childhood to adulthood. Lifestyle plays an important role in the development and maintenance of obesity. Behavior modification programs targeting eating, exercise, and diet behaviors continue to be the mainstay for treating obese children. Although family-based behavioral weight management programs have resulted in significant improvements in weight status, maintaining improvements in weight status continues to be a challenge, with many interventions resulting in considerable relapse. Motivational interviewing is one innovative approach, used alone or in conjunction with standard behavioral modification programs, which has been proposed to have the potential to enhance motivation for change and therefore improve long-term treatment outcomes for obese children. A broad literature search using two electronic databases, Medline and PsycINFO, to identify studies that used an intervention with a motivational interviewing component to modify diet and/or physical activity in the prevention or treatment of childhood obesity identified two studies that targeted weight as a primary outcome. The studies reviewed indicate that, although initial findings are encouraging, further research is needed to determine the effectiveness of motivational interviewing for prevention and treatment of childhood obesity. Concerted efforts are clearly needed to elucidate the mechanisms for maintenance of initial treatment gains, as well as the ultimate achievement of more ideal weight once formal treatment ceases.