Table 1 Participant inclusion and exclusion 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).