The GEM (Goals for Eating and Moving) Study

The GEM intervention leverages the patient-centered medical home model by using the GEM tool to provide individually tailored, patient-centered care, promote standardized weight management counseling by health coaches and primary team members, coordinate care between teams and other weight management service providers/programs (e.g., dietitians, health educators, DPP), and provide feedback to the provider and primary care team about patients' weight management-related goals, progress, and care.

To establish the efficacy of the GEM intervention, investigators will conduct a cluster randomized controlled 12-month intervention of 19 primary care teams at two urban healthcare systems with Medical Home models of care to compare the GEM intervention (intervention arm) with Enhanced Usual Care (educational materials; control arm). The specific aims of this study are: * Test the impact of the GEM intervention on weight change, and clinical and behavioral outcomes. * Identify predictors of weight loss in the GEM intervention arm related to: a) goal-setting processes and b) intervention components * Determine the impact of the GEM intervention on obesity-related counseling practices and attitudes in primary care providers.