Paediatric obesity is more prevalent in rural areas, yet rural families may not have access to paediatric obesity treatment programmes. The use of new technologies, particularly telemedicine, has proven effective in other behavioural fields, such as psychiatry. This paper reviews the literature on the use of telemedicine in paediatric obesity treatment and describes one tertiary-care paediatric obesity telemedicine programme. We performed a systematic review of the literature from 1990 to 2011 using the following criteria: paediatric age group, overweight or obesity care or treatment, and use of telemedicine technology. Of 2873 abstracts identified, four studies met all inclusion criteria; all were published after 2008. The limited evidence suggests telemedicine to be a promising approach to paediatric weight management, particularly for rural families with limited access to treatments. We also provide important lessons learnt from one paediatric obesity treatment clinic offering services to rural families via telemedicine. Few studies have examined the use of telemedicine for paediatric obesity treatment, but the available data favour this method for treating rural patients. There are several unique key factors influencing successful delivery of a paediatric obesity telemedicine treatment programme. This review identifies a potential avenue for expanded treatment and highlights the need for further investigation.