Patient description: The patient is a 32-year-old obese woman who came to the clinic with weight concerns. She is 165 cm tall and her weight is 113 kg. She is complaining of sleep apnea, PCO and dissatisfaction with her body shape. She is a high-school teacher married for 5 years. She doesn't use any contraceptive methods for the past 4 months and she had no prior pregnancies. She doesn't smoke or use any drugs. She likes to try diets and exercise to lose weight. She completed the four square step test in 14 seconds. Her BP: 130/80, HR: 195/min and her BMI is: 41.54. Her labs: FBS: 98 mg/dl TG: 150 mg/dl Cholesterol: 180 mg/dl LDL: 90 mg/dl HDL: 35 mg/dl Her cardiac assessment is normal. Her joints and ROM are within normal.

Clinical trial eligibility criteria: eligible ages (years): 18.0-70.0,  Spinal Cord Injury Cardiovascular Diseases Obesity a. 1. Men and Women with SCI/D > 1 year, aged 18-70 years. 2. American Spinal Injury Association (AIS) Impairment scale A-D Spinal Cord Levels C5-L1 3. Any one or more of the following: 1. Waist circumference >94 cm (37 inches) 2. BMI ≥ 21 kg/m2 3. Fasting dyslipidemia (either; High-density lipoprotein cholesterol (HDL-C)≤ 40mg/dL (men)/≤50 mg/dL (women), or Triglycerides (TG) ≥ 150 mg/dL). AND, 4. Linked with caregivers: Men and women 18-70 years who consent to co-enroll in the study with their partner. Caregivers are defined as: Family member, significant others or friends living with a disabled (SCI/D) partner who provide social and/or physical support including personal assistance, routine emotional encouragement and/or social interaction  for Participants with SCI/D: 1. Participating in at least 30 minutes of moderate intensity physical activity on at least three days of the week for at least three months. 2. Diet involving moderate caloric restriction for at least 6 months resulting in weight loss/gain ≥ 10% of total body mass 3. Surgery within 3 months. 4. Grade 3-4 pressure ulcer within 3 months; 5. limb pain that limits exercise 6. recurrent acute infection or illness 7. pregnancy 8. previous myocardial infarction (MI), or cardiac surgery for Caregiver Participants: 1. Participating in at least 30 minutes of moderate intensity physical activity on at least three days of the week for at least three months 2. Diet involving moderate caloric restriction for at least 6 months. 3. weight loss/gain of 10% within the preceding 6 months 4. Surgery within 3 months. 5. upper limb pain that limits exercise 6. pregnancy 7. Previous myocardial infarction (MI), cerebrovascular accident (CVA) or cardiac surgery that limits exercise. 8. Type I or II diabetes by World Health Organization (WHO) Other exclusions applying to groups: 1. The following drugs: anti-hyperglycemic agents, and lipid-altering agents within the past 6 months. Women who become pregnant will be advised to notify study personnel, will be tested, and if found to be pregnant discharged from the trial. There is no harm caused by exercise and diet in early pregnancy. Women must wait 6 months after child delivery to enter the study a criterion of the Diabetes Prevention Program. 2. Individuals with a diagnosis of pre-diabetes if, after 2 months of intervention the following diagnostic of the American Diabetes Association (ADA) are observed: Fasting Blood Glucose (FBG) 110-126mg/dL after a fast of 8 hours OR 2 hyperglycemia symptoms (i.e. Polyuria, polydipsia and unexplained weight loss) and a causal plasma glucose ≥200 mg/dL. In the absence of unequivocal hyperglycemia, these will be confirmed by repeat testing per (ADA) criteria. Should repeat testing confirm diabetes, subjects will be discharged and referred for medical treatment