Our study assessed how primary care providers in a large outpatient network follow ECR guidelines with regards to laboratory screening for comorbidities of obese patients in the 9 to 11 year age group. This retrospective cohort study included 706 patients seen in an outpatient network with a 10 year well child check from 7/1/17 to 7/1/18 and a BMI greater than or equal to the 95th percentile. Our study found 42% of patients, who met ECR guidelines, had no lipid screening or obesity co-morbidity screening obtained. The most frequently abnormal test was the lipid panel, at 23%, and notably 16 % of Hemoglobin A1C screening resulted pre-diabetic range. Our study serves as an updated review of ECR compliance in a large primary care network and suggests an opportunity to enhance education on screening recommendations.