Inclusion criteria | |
---|---|
1. | Age 18 years or older; |
2. | Body mass between 30 and 55 kg/m2; |
3. | One or more CHD risk factors: |
 |    a) Systolic blood pressure between 130 and 200 mmHg; |
 |    b) Diastolic blood pressure between 80 and 105 mmHg; |
 |    c) Total cholesterol > 180 mg/dL; |
 |    d) LDL cholesterol > 120 mg/dL; |
 |    e) HDL Cholesterol < 40 mg/dL; |
 |    f) Triglycerides > 150 mg/dL; |
 |    g) HbA1c between 6.0 and 11.5%; |
 |    h) Fasting plasma glucose between 95 and 400 mg/dL; |
 |    i) Diagnosis of Type 2 diabetes; |
4. | Residing in catchment area of the Fair Oaks Clinic and receiving primary care at Fair Oaks Clinic. |
Exclusion criteria | |
1. | Inability to speak Spanish; |
2. | Unwilling to attempt weight loss; |
3. | Significant medical co-morbidities, including uncontrolled metabolic disorders (e.g., thyroid, diabetes, renal, liver), unstable heart disease, advanced heart failure, and ongoing substance abuse; |
4. | Taking more than 10 prescription medications; |
5. | Psychiatric disorders requiring antipsychotics or multiple medications; |
6. | Body weight change > 25 lbs. in the preceding 3 months; |
7. | Pregnant, planning to become pregnant, or lactating less than six months; |
8. | Family household member already enrolled in the study; |
9. | Current or planned participation in a study that would limit full participation in VAFO; |
10. | Refusal of home visits by study staff; |
11. | Resident of a long term care facility; |
12. | Plans to move during the study period (24 months post-randomization); |
13. | Investigator discretion for clinical safety or adherence reasons (e.g., unstable housing, |
 | chronic pain that impedes physical activity). |