Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care

Inclusion Criteria: * Ethnicity: All ethnic groups; * Body mass index 25.0-39.9 kg/m2; * Fasting plasma glucose between 100 and 125 mg/dL; * Any two of the following: Waist circumference \>40 inches in men, \>35 inches in women (if in Asian American ≥ 35 inches in men; ≥31 inches in women); Triglycerides \>150 mg/dL; High-density lipoprotein cholesterol (HDL-C) \<40 mg/dL in men, \<50 mg/dL in women; Systolic blood pressure \>130 mm Hg or diastolic blood pressure \>85 mm Hg. * Having a primary care physician (PCP) at the PAMF Los Altos Center; * Seen in primary or specialty care in the Palo Alto Region at least once in the preceding 24 months; * A PAMF patient for ≥ 12 months; * Able and willing to enroll and meet the requirements of the study. Exclusion Criteria: * Inability to speak, read or understand English; * No regular access to a computer with Internet and email capabilities; * Triglycerides \>400 mg/dL; * Systolic blood pressure \>160 mm Hg or diastolic blood pressure \>100 mm Hg; * Initiation or change of drug therapy for elevated blood pressure or abnormal lipid levels within the past 3 months * Having a medical (e.g., celiac disease) or social condition (e.g., religious beliefs) that precludes dietary changes; * Having a medical or physical condition that make moderate intensity physical activity (like a brisk walk) difficult or unsafe; * Use of weight-loss medications in the past 3 months; * Regular use (\> 5 days/month) of medications that affect appetite or weight (e.g., oral corticosteroids, insulin, certain oral hypoglycemics, certain antidepressants, etc.); * Currently enrolled in a lifestyle intervention program at PAMF or elsewhere; * Planning to undergo a bariatric surgery during the study period; * Diagnosis of Type 1 or Type 2 diabetes mellitus; * Significant medical co-morbidities, including uncontrolled metabolic disorders (e.g., thyroid, renal, liver), heart disease, stroke, and ongoing substance abuse; * Renal insufficiency (i.e., GFR \< 60 mL/min/1.73m2) * Diagnosis of psychiatric disorders that would limit adequate informed consent or ability to comply with study protocol; * Diagnosis of cancer (other than non-melanoma skin cancer) that was active or treated with radiation or chemotherapy within the past 2 years; * Diagnosis of a terminal illness and/or in hospice care; * Pregnant, lactating or planning to become pregnant during the study period; * Already enrolled or planning to enroll in a research study that would limit full participation in this study or confound the observation and interpretation of the study's findings; * Family/household member of another study participant or of a study staff member; * No longer a PAMF patient or planning to transfer care outside of PAMF during the study period; * Planning to move out of the area during the study period; * PCP determination that the study is inappropriate or unsafe for the patient; * Investigator discretion for clinical safety or protocol adherence reasons.