BACKGROUND: American Indian (AI) youth are at high risk for type 2 diabetes. OBJECTIVES: To partner with Eastern Band of Cherokee Indians and Navajo Nation to develop a culturally-sensitive behavioral intervention for youth (Tribal Turning Point; TTP) and assess feasibility in an 8-month randomized pilot study. METHODS: We enrolled 62 overweight/obese AI children (7–10 years) who participated with ≥1 parent/primary caregiver. Intervention participants (n=29) attended 12 group classes and 5 individual sessions. Control participants (n=33) attended 3 health and safety group sessions. We analyzed group differences for changes in anthropometrics (BMI, BMI z-score, waist circumference), cardiometabolic (insulin, glucose, blood pressure) and behavioral (physical activity and dietary self-efficacy) outcomes. RESULTS: Study retention was 97% and intervention group attendance averaged 84%. We observed significant treatment effects (p=0.02) for BMI and BMI z-score: BMI increased in control (+1.0 kg/m(2), p