 Our secondary hypotheses are: 1 that the weight loss at year 2 and 5 in the intensive medical group is associated with improvements in blood pressure, fasting glucose, lipids, health-related quality of life and psychosocial measures and is greater improvement than that achieved with usual medical care and access to a website; and 2 that total medical costs in the intensive medical management group will compare favorably to total medical costs in the usual care group i.e., total reimbursement from insurance costs will be less, even when the expense of the treatment is considered. 