Many children with excess weight and obesity struggle with comorbid psychiatric disorders and family stressors. These dual diagnosis presentations may be underestimated in epidemiologic surveys and frequently constitute exclusion criteria in childhood obesity treatment studies. As a result, clinical paradigms for this population are lacking and even multispecialty pediatric obesity centers do not provide comprehensive services to these children and their families. Hence, the need for this article, which is a preliminary exploration of possible dynamic mechanisms connecting several psychiatric diagnoses in childhood and excess weight. Based on correlations reported in the literature, depression, oppositional disorder, and attention-deficit/hyperactivity disorder are offered as examples of linear and reciprocal relationships between the two conditions. Notably, eating may be viewed as a means of regulating emotion (depression) and family conflict (oppositionalism) as well as reflecting a lack of regulation (attention-deficit/hyperactivity disorder). This article will hopefully generate subsequent research efforts in this area and enhance practitioner awareness of the complexity of providing effective services to this population.