Background: Health disparities and low-income backgrounds play a role in obesity and its comorbidities. Tertiary care pediatric Weight Management Clinics (WMC) have a high initial visit no-show rate. In 2022, we implemented a virtual WMC pre-visit group orientation (JUMP START), decreasing our no-show rate from 31% to 14%. However, patients insured by Medicaid had a higher no-show rate at 16% compared to 7% in those privately insured. Our new project aimed to decrease this to 13% in a nine-month period. Methods: A multidisciplinary team used an A3 quality improvement framework to identify root causes and improvement approaches. Iterative improvement cycles included: (1) modification of script used to schedule patients, and (2) conducting two JUMP START sessions in Spanish. Primary outcome measure was the initial visit no-show rate for patients with Medicaid. We also reviewed data on no-show rescheduling rates. Results: 356 patients (35% of referrals) attended JUMP START from July 2022 to Mar 2023 (37% privately insured, 60% Medicaid insured and 3% self-pay). A total of 256 attendees scheduled an initial visit from Sept 2022 to May 2023. No-show rate for the initial scheduled visit was 15.6% (n = 40; 19.2% Medicaid, 10.2% private). 19% of no-show patients rescheduled and 47% of those attended and another 18% have pending appointments. Conclusions: Prior improvement work reduced initial visit no-show rates in our WMC, but disparities by insurance status existed. Improving scheduling scripts and offering the pre-visit virtual orientation in Spanish did not change the differential between the rates of no-show of Medicaid insured and private insured patients. A small group of patients many of them on Medicaid rescheduled after a no-show and attended the rescheduled visit. Ongoing improvement is needed to reduce barriers to attending JUMP START and the first visit. Next steps include revisiting root causes, addressing caregiver identified barriers and additional help to reschedule and attend missed visits.