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Background: Childhood obesity continues to be prevalent while the effects of the recent COVID-19 pandemic only add to the problem. Although physicians give exercise recommendations for children and adolescents with obesity, there is no primary care provider giving specific exercise recommendations and plans for these patients. The purpose of this case study is to describe a possible treatment plan for an obese pediatric patient with lower extremity pain as well as strength, mobility, and endurance deficits, discuss supporting evidence, and examine the role of physical therapy in the approach to weight loss. Case description: A 12-year-old male tripped and fell down a set of stairs, causing him to visit his primary care provider. He was referred to physical therapy for pain management and an intensive weight loss plan. Initial physical therapy evaluation revealed knee pain, lower extremity weakness, decreased endurance capabilities, and a high BMI that categorized him as severely obese. Intervention: Physical therapy in a rural outpatient clinic focused on pain management, strengthening, balance, and endurance training. The patient was given a home exercise plan to manage care at home. Outcome Measures: Throughout the treatment plan, the patient improved with strength testing, 6MWT distance, and pain rating. However, the patient was unsuccessful with weight loss and gained weight throughout his 19 weeks of physical therapy. Discussion: Physical therapy could be a successful addition to the multidisciplinary care team utilized in the treatment of pediatric obesity. An individualized treatment plan that requires the support and adherence of the patient and patient’s family is likely the best strategy for improved outcomes.