FRESH Study (Fitness, Relaxation and Eating to Stay Healthy)

Inclusion Criteria: * Study participants must: 1. Be capable of giving informed consent 2. Understand and voluntarily sign the informed consent form. 3. Be females at least 18 years of age and identify themselves as African-American 4. Have prediabetes as defined by the American Diabetes Association: history of glycated hemoglobin (HgbA1c) 5.7-6.4 % or fasting blood glucose 100-125 mg/dL (5.6-6.9 mmol/L) (fasting defined as no caloric intake for at least 8 hours), or a 2-hour plasma glucose 140-199 mg/dL (7.8-11.0 mmol/L) during an oral glucose tolerance test (as described by the World Health Organization using a glucose load of 75 g anhydrous glucose dissolved in water) 5. Have a body mass index (BMI, defined as weight in kilograms divided by height in meters squared) greater than or equal to 25 Exclusion Criteria: 1. Current or previous diagnosis of diabetes or a history of HgbA1c ≥ 6.5% or fasting blood glucose ≥ 126 mg/dL (7.0 mmol/L) (fasting defined as no caloric intake for at least 8 hours), or a 2-hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test or a history of classic symptoms of hyperglycemia or hyperglycemic crisis and a random plasma glucose ≥ 200 mg/dL (11.1 mmol/L). 2. Normal glycemia or a currently with a HgbA1c \< 5.7% or fasting blood glucose \< 100 mg/dL (7.0 mmol/L) (fasting defined as no caloric intake for at least 8 hours), or a 2-hour plasma glucose \< 140 mg/dL (11.1 mmol/L) during an oral glucose tolerance test 3. Current or past use of oral hypoglycemic agents (including, but not limited to, metformin, rosiglitazone, pioglitazone, glipizide, and glyburide) or insulin 4. Male gender 5. History of congestive heart failure 6. History of renal failure, dialysis, or creatinine greater than 2 mg/dL 7. History of liver failure or a liver dysfunction with a increase by a factor of 2 above the upper limit of normal in alanine aminotransferase or aspartate aminotransferase 8. History of gastrointestinal disorder that would prevent adherence to the recommended diet (e.g. celiac disease, inflammatory bowel disease, history of bariatric surgery, history of intestinal surgery) 9. Presence of active cancer 10. History of coronary artery disease or cerebrovascular disease 11. History of uncontrolled hypertension 12. Participation in another lifestyle modification trial 13. Pregnancy or lactating or planning to be pregnant 14. Current alcoholism or abuse of recreational drugs 15. Hospitalization for depression in past 12 months 16. Travel plans that do not permit full participation or participant lives too far from Health Center to permit full participation 17. History of bariatric surgery, small bowel resection, or extensive bowel resection 18. Chronic treatment with systemic steroids 19. Current diagnosis of schizophrenia, other psychotic disorders, or bipolar disorder 20. Inability to walk two blocks 21. Other medial, psychiatric, or behavioral limitations that in the judgment of the principal investigator may interfere with study participation or the ability to follow the intervention protocol 22. Amputation of lower limb for nontraumatic causes 23. Self report of HIV-positivity or active tuberculosis 24. Documented history of pulmonary embolus in past six months 25. Chronic obstructive pulmonary disease that would limit ability to follow the study protocol 26. Self-reported chronic hepatitis B or C or cirrhosis; inflammatory bowel disease requiring treatment in past year; Cushing's syndrome; acromegaly (clinical diagnosis or self-report); any major organ transplant 27. Unwilling or uninterested in participating in group lifestyle education sessions 28. Current regular corticosteroid use 29. Active polycystic ovarian syndrome