Adaptation of the Diabetes Prevention Program for Primary Care

Inclusion Criteria: * Age 18 to 79 * Able to give informed consent * Able to keep a food record for 7 days prior to study entry and to complete 2 screening visits and a blood draw prior to enrollment * Willing to attend all counseling sessions, to complete study-related assessments, and to be randomized to a treatment condition after 6 months of treatment * Has a regular primary care physician (if referred from outside the University of Colorado system) * Body mass index (BMI) ≥ 30 kg/m2 and \< 50 kg/m2 * Elevated waist circumference (≥ 88 cm for women, ≥ 102 cm for men) + any one of the following: * Glucose intolerance (fasting glucose ≥ 100 or non-fasting glucose ≥ 140, including type 2 diabetes); individuals taking medications for diabetes qualify automatically * Elevated blood pressure (≥ 130/85), including hypertension (≥ 140/90); individuals taking anti-hypertensive medication qualify automatically * Hyperlipidemia/dyslipidemia, including any of the following: hypertriglyceridemia (TG ≥ 150); low HDL cholesterol (\< 40 for men, \< 50 for women); or taking lipid-lowering medications * Obstructive sleep apnea - Exclusion Criteria: * Medical conditions in which significant weight loss is normally contraindicated (e.g. pregnancy, congestive heart failure requiring diuretics, poorly controlled diabetes, Stage 4 or 5 chronic kidney disease, clinically evident cirrhosis, other severe internal organ disease); exceptions may be made if a referring physician documents that it is safe and appropriate for the individual to lose weight * Treated for cancer within the past 5 years, except for basal cell or squamous cell skin cancer; exceptions may be made with written permission from a physician * Myocardial infarction or stroke within the past 6 months * Poorly controlled hypertension (≥ 160/100); may be re-screened when controlled * Poorly controlled diabetes (hemoglobin A1c ≥ 10.0); may be re-screened when controlled * Weight gain or loss of ≥ 5% of weight in the past 6 months; patients who have not been weight stable may be re-screened * Chronic use of corticosteroids or second-generation antipsychotic medications (exceptions may be made for individuals using these medications who have been weight stable for 6 months) * Psychiatric diagnoses likely to affect adherence to a research study protocol (e.g., poorly controlled schizophrenia, active substance abuse) * Untreated major depression (PHQ-9 score ≥ 20) * Pregnant or trying to become pregnant * Social situation precluding participation in a research study (e.g., need to care for a small child or an elderly parent) * Prior or planned bariatric surgery * Participation in an organized weight loss program (e.g., Weight Watchers) at the time of enrollment