 This study is a cluster-randomized, two-arm controlled trial in primary care settings. A total of 18 primary care clinics inclusive of low income populations with a high percentage of African Americans from urban and rural areas across Louisiana will be randomized to either 1 intervention or 2 usual care. The sample will include 800 obese BMI 30-50 kgm2 patients 18 clinics, 44 patients clinic. The primary aim of this trial is to develop and test the effectiveness of a 24 month, patient-centered, pragmatic and scalable obesity treatment program delivered within primary care, inclusive of an underserved population. Patients in the intervention arm will attend weekly 15 in-person sessions in the first six months, followed by monthly sessions for the remaining 18 months. The behavioral intervention will be delivered by a trained health coach embedded in the primary care clinic. Primary Care Practitioners in the intervention arm will receive a series of webinars on obesity science to help them manage and treat obese patients. Patients assigned to the usual care arm will continue to interact with their Primary Care Practitioner according to their usual schedule, and will receive a series of newsletters on topics of interest, including importance of sleep for health, household money management, family coping skills, smoking cessation, etc. Primary Care Practitioners in the usual care arm will receive a webinar describing the current Centers for Medicare and Medicaid Services CMS approach to reimbursing for obesity treatment, and a reminder informational brochure will be sent to the Primary Care Practitioners each year. Patients in both arms will be assessed on primary and secondary outcome measures at baseline, and at 6, 12, 18 and 24 months of intervention. 