Tailored pain management strategies are urgently needed for youth with co-occurring chronic pain and obesity; however, prior to developing such strategies, we need to understand parent perspectives on weight in the context of pediatric chronic pain. Participants in this study included 233 parents of patients presenting to a multidisciplinary pediatric chronic pain clinic. Parents completed a brief survey prior to their child's initial appointment; questions addressed parents' perceptions of their child's weight, and their perceptions of multiple aspects of the relationship between their child's weight and chronic pain. The majority (64%) of parents of youth with obesity accurately rated their child's weight; this group of parents was also more concerned (p < 0.05) about their child's weight than parents of youth with a healthy weight. However, the majority of parents of youth with obesity did not think their child's weight contributed to his/her pain, or that weight was relevant to their child's pain or pain treatment. Overall, only half of all parents saw discussions of weight, nutrition, and physical activity as important to treating their child's pain. Results support the need for addressing parents' perceptions of their child's weight status, and educating parents about the relationship between excessive weight and chronic pain.