Weight Loss Physical Disabilities

Eligibility Details: Inclusion Criteria: - A permanent MRD (>= 1 yr. duration) requiring the use of a wheelchair or resulting in the inability to walk 0.25 miles without stopping, with or without assistive devices, as documented by 7 items from the NHANES Physical Funding Survey (113), and confirmed by the Primary Care Physician (PCP). Individuals with MRDs, associated with, but not limited to spinal cord injury (SCI), spina bifida, multiple sclerosis, cerebral palsy, stroke, muscular dystrophy, and lower limb amputation will be included. - Age 18 to 65 yrs. Weight management for younger or older individuals requires different behavioral strategies. - Body mass index (BMI) 25 to 45 kg/m squared. Individuals with BMI, with a BMI <25kg/m squared are not overweight, and individuals with a BMI >45 kg/m squared require more aggressive weight loss interventions, e.g., surgery, medication, etc. We are aware of the difficulty in the assessment of BMI, and issues related to the use of BMI for classifying overweight/obesity in individuals with SCI or amputations (114-116). Thus, in questionable cases we will defer to the PCP regarding eligibility based on weight status. - Wireless internet access in the home. Exclusion Criteria: - Unable to participate in light-to-moderate intensity PA, e.g., seated aerobics, resistance exercise, or physically unable to use the iPad. - Participation in a structured weight loss or exercise program in the previous 6 mos. These proximal exercises may influence this trial. - Current exercise (>3, 30-min bouts of planned exercise/wk.). - Not weight stable (plus/minus 4.6 kg) for 3 mos. prior to intake. - Unwilling to be randomized. - Pregnancy during the previous 6 mos. currently lactating, or planned pregnancy in the following 18 mos. - Serious medical risk, e.g., cancer, recent heart attack, stroke as determined by the PCP. - Current use of antipsychotics, untreated depression, or other psychiatric illness that would preclude participation in weight management, as determined by the PCP. Psychiatric co-morbidity may limit the benefits from health education. Addressing psychiatric issues is beyond the scope of this study. - Cognitive, visual, or hearing impairments that may interfere with compliance to the study protocol as determined by the PCP. - Adherence to specialized diets, e.g., food allergies, vegetarian, macrobiotic. - Binge (Binge Eating Scale) (117) or other eating disorders (EATs-26) (118). - Living in the same household as another study participant.