Background: Childhood obesity is a significant risk factor for the development of adult obesity, cardiovascular disease (CVD), and diabetes. Recent studies suggest very high rates of obesity in American Indian (AI) children. Candidate: This K23 award will facilitate Dr. Alexandra Adams' development as a patient-oriented scientist with a long-term goal of becoming a high-quality, independent academic investigator who develops intervention strategies for prevention of obesity, CVD and diabetes in Al populations. Qualifications: Dr. Adams' unique qualifications for this K23 award include her medical training and a Ph.D. in nutritional science. Since joining the University of Wisconsin (UW) Family Medicine (DFM) clinical and research faculty in 1999, she has established a strong working relationship with Al communities in Wisconsin and has initiated a number of important collaborative studies with tribal communities. Environment: The DFM and Medical School are committed to Dr Adams' development as a patient-oriented scientist. This is reflected in strong support letters, senior research mentors involved with the project, written commitment from her Chair, GCRC support, and collaborative opportunities with other UW research teams in one of the strongest research environments in the US. Training: Dr. Adams will develop her career in patient-oriented research by obtaining advanced training in clinical research design, blostatistics, participatory research, ethics, writing skills, and advanced body composition techniques. As part of her K-23 plan, She will complete the UW Clinical Investigator Preparatory Pathway (CIPP K30 grant) as well as participate in courses, seminars and training activities. She will receive extensive group and one-on-one mentoring from a number of LTW senior NIH-funded scientists and Dr. Ann Macaulay, Director of the Kahnawake Schools Diabetes Prevention Program at McGill University. Research: Dr Adams is working on a three phase collaborative participatory research project with two WI tribal communities who have asked her to partner with them to reduce the disease burden in their communities by decreasing obesity and CVD risk factors in their children. She hypothesizes that the high prevalence of obesity in WI Al children, which places them at high risk for adult CVD and diabetes, begins early in childhood. Thus, obesity prevention efforts must be targeted early in childhood. The project will 1) assess obesity prevalence and cardiac risk factors in Al children ages 0-7, 2) conduct growth modeling of the familial and environmental determinants of obesity, and 3) work in partnership with the communities to design community-based early intervention strategies to prevent childhood obesity. Significance: With the assistance of the K23 award, Dr. Adams will develop and test interventions to prevent obesity in Al children and its sequelae; CVD and diabetes.