Program to Reduce Incontinence by Diet and Exercise

Inclusion Criteria: * aged ≥ 30 years and not institutionalized * body mass index 25 to 50 kg/m2 * urinary incontinence symptoms for \> 3 months by self-report and record \> 10 incontinent episodes per week on a 7-day urinary diary * able to complete a behavioral run-in consisting of self-monitoring of food and activity * report having a primary health care provider * able to understand and sign informed consent and complete baseline questionnaires * agree to not initiate new treatment for incontinence or weight reduction, including behavioral, pharmacological or surgical therapies, for the duration of the study Exclusion Criteria: * current use, or use within the previous month of medical therapy for incontinence * currently pregnant or gave birth in the previous 6 months * current urinary tract infection (dipstick urinalysis positive for leukocyte esterase, nitrites or blood) or report having \> 4 urinary tract infections in the preceding year * incontinence of neurologic or functional origin (by history) * self-report of prior anti-incontinence or urethral surgery, pelvic cancer or pelvic irradiation * self-report of significant medical conditions of the genitourinary tract (genitourinary fistula, interstitial cystitis, symptomatic pelvic organ prolapse) * report a medical condition that would affect the safety and/or efficacy of a weight management program involving diet and physical activity, including type 2 diabetes requiring medical therapy that may cause hypoglycemia, chronic steroid use or uncontrolled hypertension (systolic blood pressure \>180 mm Hg or diastolic blood pressure \> 100 mm Hg); women with a history of coronary heart disease may participate with written approval from their primary care physician * currently engaged in an active weight loss program and/or experienced a 10% or greater weight reduction in the past 3 months * report being unable to walk 2 blocks (1/4 mile) without stopping * report conditions that, in the judgment of the Clinical Center Principal Investigator, render potential participants unlikely to follow the protocol for 18 months, including illness likely to be terminal within 2 years, plans to move, substance abuse or other significant psychiatric problems, or dementia * participating in another research study that involves investigational drugs or can potentially confound the results of PRIDE