Overweightobesity is pervasive after SCI and contributes to accelerated cardiovascular disease and comorbid with dyslipidemia, glucose intolerance, and insulin resistance, and is far more difficult to manage and reverse than obesity occurring in persons without disability. It is generally recommended that overweightobese individuals lose weight by undertaking regular physically activity and consuming an energy-restricted diet to improve quality of life and reduce disease risk, although a demonstration to this effect has never been produced in persons with SCI. Here we examine the efficacy of a SCI-specific structured therapeutic lifestyle intervention TLI modeled after the landmark Diabetes Prevention Program DPP on obesity and component disease risks. The TLI consists of a 6-month clinical program incorporating 3x weekly circuit resistance training, Mediterranean-style calorie restricted diet 1200-2000 kcalday, 16 educational sessions with a lifestyle coach, and a 6-month quasi-supervised extension maintenance phase. Preliminary results indicate that TLI successfully reduced body weight, improves markers of disease risk, and improves cardiopulmonary and dynamic strength fitness attributes.