We developed and tested the feasibility of a behavioral intervention that utilizes clinic and home visitations to reduce overweight in preschool children above the 95(th) BMI percentile. Five families of preschool children ages 2 to 5 years with a BMI above the 95(th) percentile and one overweight parent were enrolled in a 24-week behavioral weight management program. Phase I, Intensive Treatment included 12 weekly sessions, alternating group-based clinic sessions and home settings. Phase II, Maintenance included 6 bi-weekly sessions alternating between the clinic and home setting. Treatment focused on teaching parents to use behavioral child management strategies to systematically implement dietary changes across beverages and snacks, meals, and to increase physical activity. Home visits focused on modifying the home food environment and in vivo use of child behavior management skills. Treatment targeted either weight maintenance or a small weight loss. Outcome measures were obtained at baseline (week 0), end of treatment (week 24), and at 6 month follow up after treatment ended (week 52). Three participants completed 24 weeks of treatment and were compared to two participants who did not complete treatment. Treatment completers showed reductions in zBMI and percent overweight while two noncompleting families increased their percent overweight and maintained their zBMI at 6 month follow up. These results suggest initial support for development of a behavior-based weight management intervention for obese preschool children and their families. Intervention targets appear to be enhanced by the inclusion of home visitations, in which food environments are changed to facilitate treatment goals.