For decades, clinical and public health recommendations have advised overweight and obese adults to eat more healthfully, adopt regular physical activity, and lose weight. Unfortunately, such advice unaccompanied by ongoing support is rarely sufficient to enable the adoption of healthier behaviors. In this issue, the Community Preventive Services Task Force delivers new recommendations for health care systems and community organizations to offer combined diet and physical activity promotion programs that provide counseling and longitudinal support for persons at increased risk for type 2 diabetes (1). This recommendation follows 2 related systematic reviews that evaluated available evidence for the effectiveness and cost-effectiveness of combined diet and physical activity promotion programs (2–3). Evidence suggests that programs that achieve a mean weight loss at 1 year of just 2.5% confer a 60% reduction in diabetes development at 6 years, with approximately one half of patients reverting to normal glucose levels (2). Programs based on the U.S. Diabetes Prevention Program (DPP) or Finnish Diabetes Prevention Study interventions yielded a 2-fold greater weight loss (mean, 3.0% [95% CI, 1.9% to 4.1%]) than less structured approaches (2). Although programs adapted from the DPP are generally considered “resource-intensive,” their median cost was only $424 per person, or approximately 25% of that of the original DPP lifestyle intervention (3). Alas, if every overweight or obese American adult participated in such a program, the total bill would approach $71 billion ($424 times 168 million people), which raises important questions for stakeholders. Are there “priority” populations that benefit most from access to intensive combined diet and physical activity promotion programs? Should society or health systems pay for these interventions if an individual is unable? Are different forms of delivery more effective or cost-effective than others? Can effective programs be scaled nationally?