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To document parenting stress in caregivers of treatment-seeking youth with obesity and examine whether parenting stress is a predictor of pediatric health indicators, including body mass index and weight or obesity-specific health-related quality of life.Youth (5–18 years) and their caregivers presenting to a pediatric medical weight management program initial visit completed several self-report questionnaires assessing demographics, parenting stress, and weight or obesity-specific health-related quality of life. Youth's height and weight were measured by trained clinic nurses and abstracted from the patient medical records. Study staff measured caregiver's height and weight.Participants included 120 caregivers and their youth (Mage = 11.0, 65.8% female, and 50% African-American). At treatment initiation, caregivers were primarily obese (Mbody mass index = 35.8). One fifth of caregivers of school-aged children (18%) had clinically increased levels of parenting stress, and 25% reported increased spousal discord specific to parenting. Parenting stress did not significantly predict youth body mass index. Parenting stress significantly predicted obesity-specific parent-proxy health-related quality of life for school-aged children but not self-reported obesity-specific health-related quality of life.Given that caregivers are critical components of pediatric weight management interventions, those with clinically increased levels of parenting stress would likely benefit from brief problem-solving interventions and anticipatory guidance to address common obstacles when fostering healthier lifestyles for their youth.