We aimed to reduce attrition of newly referred patients in a pediatric weight management program by implementing an Orientation to address families’ expectations and screen for and support behavioral and mental health problems and psychosocial stressors at program outset. Orientation impact was monitored with run charts with percentages of scheduled encounters completed. Long-term impact was assessed by comparing patients in the initial 6 months of the Orientation to a baseline group of referred patients during the same 6-month time interval in the prior year (Pre-Orientation Group). The outcome measure was program attrition within 15 months. Groups were compared using Kaplan-Meier survival analysis and Cox proportional hazards regression modeling. Patients in the Orientation group had a 23% increased odds of attrition compared to patients in the Pre-Orientation group (aHR 1.23; 95% CI 1.01, 1.51) and shorter median duration of follow-up (2.0 vs. 2.9 months, p=0.004). An increase in BMI z-score of 1 unit resulted in a nearly 5-fold increased odds of attrition (aHR 5.24; 95% CI 2.95, 9.3). An orientation for new patients did not reduce attrition within 15 months. We suggest that ongoing retention strategies should be embedded into the treatment phase of the program.