Project Summary/Abstract Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent public health problem that disproportionately hurts Mexican and Central Americans (M/CA). Weight loss through behavioral changes in diet and physical activity can lead to reductions in liver fat, injury, and fibrosis, but is rarely successfully achieved. Targeted behavioral weight loss interventions may improve the outcomes of M/CA patients with NAFLD. However, little is known about the personal, cognitive, and social factors that, if changed, may lead to improved weight loss rates and avert complications. The objective of this proposal is to identify the barriers to health behavior change experienced by M/CA patients with NAFLD and to adapt and test a weight loss intervention to address their needs. Dr. Maya Balakrishnan is a clinician investigator with a strong foundation in clinical hepatology and epidemiology that has positioned her to advance toward her goal of improving NAFLD outcomes among minority communities. Through this NIMHD K23 Mentored Patient Oriented Career Development Award, Dr. Balakrishnan will obtain experience in developing, implementing, and testing behavioral interventions, with a special focus on weight loss among M/CA patients with NAFLD. She will train in qualitative methods to gain an in-depth understanding of patients’ experience with weight loss behaviors. She will gain experience in the adaptation, implementation, and testing of behavioral interventions in the context of health disparities. With her inter-disciplinary team of mentors, Dr. Balakrishnan intends to use the Harris County NAFLD Cohort, a unique cohort of predominantly M/CA patients with NAFLD, as the source of data and participants for her proposed aims. Among M/CA patients with NAFLD, she will 1) identify the personal, cognitive and sociostructural barriers to weight loss behavioral change (Aim 1), 2) adapt the Look AHEAD lifestyle intervention for their needs through feedback