Most health coaching (HC) interventions have been delivered through telephone, web-based chatting, or face-to-face instruction. Despite the potentially positive impact of group-based HC by video conferencing (VC) on weight loss and metabolic health, individualized VC sessions have not been studied. PURPOSE: To assess changes in physical activity, body mass, metabolic markers (fasting blood, insulin, glucose, hemoglobin A1c [HbA1c], and HOMA-IR), in obese adults. METHODS: Thirty adults (body mass index [BMI] ≥30 kg/m2) were randomly assigned to three groups video conferencing group (VC), in person (IP) group, or a control group (CG), n=10 per group). Participants received a wireless body weight scale and step-tracking accelerometer watch (Withings, Inc., Cambridge, MA, USA) to synch with their personal smartphones and apps. Participants assigned to VC and IP groups received weekly HC individualized based on data uploaded over the 12-week intervention. Steps/day and body weight loss were analyzed via analyses of covariance (ANCOVA). Between-group ANOVAs analyzed pre-and post-intervention changes in weight (kg), blood glucose, insulin, HbA1c, and HOMA-IR. RESULTS: Mean weight loss and percent weight loss (%) was greater (p≤05) for VC (8.23±4.5kg; 7.7%) than IP (3.4±2.6kg; 3.4%) and CG (2.9±3.9kg; 3.3%) respectively. Steps/day were significantly higher in VC than IP at week 4 only and VC was significantly higher than CG at weeks 6, 8, 9, and 11 (p≤.05). No within- or between- group differences were found for glucose, insulin, or HbA1C. HOMA-IR decreased for VC only (p≤.05).No between-group differences were found for any metabolic markers. However, there was a within-group decrease for HOMA-IR (p≤.05) for VC. CONCLUSION: Our innovative, multidisciplinary, telemedicine health coaching delivered through VC led to more favorable changes in weight loss, physical activity (steps/day), and HOMA-IR than in-person or no health coaching. VC may be an economical approach to improve health and promote behavior change in obese adults. Future studies using VC health coaching in group and individualized formats, and for other population subgroups, are needed to investigate impacts of weight loss on other health outcomes. Supported by NIH Grant 8UL1GM118979-02.