Local health departments (LHDs) have an important function in controlling the growing epidemic of obesity in the United States. Data are needed to gain insight into the existence of routine functions and structures of LHDs that support and sustain obesity prevention efforts. The purpose of this study was to develop and examine the reliability of measures to assess foundational LHD organizational processes and functions specific to obesity prevention. Survey measures were developed using a stratified, random sample of US LHDs to assess supportive organizational processes and infrastructure for obesity prevention representing different domains. Data were analyzed using weighted κ and intraclass correlation coefficient for assessing test-retest reliability. Most items and summary indices in the majority of survey domains had moderate/substantial or almost perfect reliability. The overall findings support this survey instrument to be a reliable measurement tool for a large number of processes and functions that comprise obesity prevention–related capacity in LHDs.