PROJECT SUMMARY American Indian (AI) youth have the highest prevalence of obesity of all ethnic groups in the United States, placing them at disproportionate risk for adult obesity and obesity-driven metabolic disease including diabetes, cardiovascular disease, high blood pressure, stroke, and cancer. In fact, greater than 41.7% of the children and adolescents from the Hopi Tribe, Pascua Yaqui Tribe, Salt River Pima-Maricopa Indian Community, and the Yavapai Apache Nation—tribal communities collaborating in the proposed study—are obese. Health behaviors can modify obesity risk and associated morbidities such as diabetes and cardiovascular disease. To enhance the impact of our efforts, we recognize the intervention must include parental support and attention to emotional well-being and coping skills through the integration of mind-body medicine (MBM). The goal of the Achieving American Indian Youth Energy and Mental Health Balance (AYEM-B) Study is to develop and test a culturally-relevant, community-led intervention that incorporates the principles of MBM skills training and parental /caregiver engagement to support AI youth in achieving healthy lifestyle choices and in reducing risk for adult obesity and related metabolic diseases. Our hypothesis is that participation in a community-led intervention that includes MBM and the family will reduce obesity-related chronic disease risk factors in AI adolescents (n=224), as assessed by changes in body mass index z-score (primary outcome) and the objective measures of moderate/vigorous physical activity and fruit and vegetable intake (secondary outcomes) at 6 months. We will test our hypothesis by addressing the following specific aims: Specific Aim 1: Integrate an existing week-long residential wellness camp program for AI adolescents with novel MBM and parental engagement components to establish a 6-month community-led obesity prevention intervention for AI adolescents (aged 10–15 years) and their parents/caregivers. Specific Aim 2: Assess the preliminary efficacy of the newly established program on body mass index z-score, physical activity and fruit and vegetable intake in American Indian adolescents at baseline, 3 and 6 months using a within-subjects design. Also, evaluate changes in individual risk factors (lipids, hemoglobin A1C, fasting glucose) pre- and post-intervention. Specific Aim 3: Evaluate indicators of successful program implementation and the potential for sustainability across participating tribal communities, including acceptability and relevance to participants, parents, and the community, and program adoption, feasibility, fidelity, and costs.