Background: There is a worldwide epidemic of obesity in children. To address obesity in children, emphasis must be on factors within family, school, and community environments. Although most parents and school officials are aware of the problem of overweight children, there are few data available to guide decision making about the acceptability of school-based body mass index (BMI) screening and referral programs. Parental insight is essential to determine the efficiency and effectiveness of BMI notification. Methods: The purpose of this qualitative study was to explore the perceptions of parents whose school-age children received a BMI referral letter stating their child is overweight. Purposeful convenience sampling was used to obtain 21 parents. Semistructured interviews were used to collect the data. Results: Eight themes and corresponding subthemes emerged. The themes regarding parental perceptions were feelings about receiving the letter, causes of obesity, capabilities, barriers, role modeling, primary care provider response, school's role, and health screening process. Conclusions: The findings of this study can serve as the foundation and provide guidance for parents, schools, healthcare professionals, and communities when attempting to implement changes and programs to combat the epidemic of childhood obesity.