Context: Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care. Purpose: To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary care. Methods: We enrolled 107 participants to a 6-month, 2-armed, randomized trial comparing a CCM for obesity with usual care. The primary outcome was weight change at 90 days. The usual care arm received educational weight loss materials and outcome assessments at day 0, 90, and 180. The active arm received the same elements as the usual care arm plus a multicomponent obesity CCM. Findings: The Day 90 mean [plus or minus] SD weight change for the active arm (n = 34) and control arm (n = 33), respectively, was -4.5 [plus or minus] 7.7 pounds and -2.4 [plus or minus] 8.1 pounds (P = 0.27 for difference). The Day 180 mean [plus or minus] SD weight change for the active (n = 27) and control (n = 27) arms, respectively, was -9.4 [plus or minus] 10.3 pounds and -2.1 [plus or minus] 10.7 pounds (P = 0.01 for difference). There was no significant change in physical activity, or fruit and vegetable intake at day 90 or day 180. Conclusions: Improving the recognition and treatment of obesity in primary care settings is a critical initiative. Rural populations suffer disproportionately with obesity, and better methods of delivering obesity care are needed for this population. Further research is needed to establish the effectiveness of a CCM approach for obesity care.