OBJECTIVE: To evaluate documentation of cardiovascular (CV) risk factors and obesity management by pediatric cardiologists. STUDY DESIGN: Review of medical records of obese (>/=95th body mass index percentile) 2-17 year-old children presenting to outpatient pediatric cardiology over 1 year. Subjects were categorized as: heart disease (HD) with increased risk for atherosclerosis; HD with average risk for atherosclerosis; or no HD. Data were evaluated on documentation of the assessment of seven CV risk factors [including recognition of elevated blood pressure (BP)] and management of obesity. Multivariable logistic regression (LR) examined physician documentation of obesity intervention by risk groups, including age and gender. RESULTS: Data on 730 subjects were analyzed; 16 % had HD with increased risk for atherosclerosis, 41 % had HD with average risk for atherosclerosis, and 43 % had no HD. Documentation of risk factor assessment was highest for physical inactivity (53 %) and recognition of obesity (47 %). Other factors (child dyslipidemia, diet, dysglycemia, and cigarette exposure) were documented less frequently. Elevated BP was found in 144 patients (20 %); 53/144 (37 %) had documentation of elevated BP recognition. An obesity intervention was documented in 62 % of records and did not significantly differ between risk groups. In the multivariate LR, physician documentation of obesity intervention did not significantly differ between risk groups. CONCLUSIONS: Complete assessment of CV risk factors in obese patients is low. The number of risk factors assessed was similar among patients with HD with average risk of atherosclerosis and HD with increased risk of atherosclerosis. Increased care coordination between cardiologists and primary care providers may lead to uniform, comprehensive CV risk assessment.