Background: Overweight children are often not identified or counseled. Purpose: We assessed the documentation rate and clinical management of overweight children before and after an electronic medical record (EMR) upgrade calculating body mass index (BMI) percentile for age and gender. Methods: Family Medicine resident and faculty physicians at two sites received an EMR upgrade; Site1 physicians also received BMI training and education. From two years before to one year after the upgrade, randomly selected charts were reviewed for all encounters with overweight children for documentation of obesity and clinical management. Results: After the EMR upgrade, documentation and counseling rates significantly improved at both sites but the rate of change was greater for Site 1; postintervention documentation was significantly greater for Site 1 vs. Site 2 (40% vs. 28%, P < 0.01). Conclusions: We found an increase in documentation and management of overweight children following an EMR upgrade that calculates BMI percentiles for age and gender. Physician education was an important adjunct.