Background: Central obesity remains a global health challenge. Up to date, there are unclear central obesity management strategic role for family-based interventions in terms of central obesity correlated health risks.

Objective: To assess the efficacy of overall family-based intervention model in modulating cardiovascular risk in adolescents` central obesity with a positive family history of cardiovascular risk.

Patients and Methods: One-thousand, and five-hundred adolescents` with central obesity participants were recruited from eight-hundred families, from Giza Governorate from January 2022 to January, 2026. Participants were aged ≥18 years old, with a positive family history of cardiovascular risk. Randomization codes utilizing a simple random model, and paramedical professionals delivered the comprehensive package of the overall family-based intervention model including annual screening for cardiovascular risk factors, structured lifestyle modification sessions, referral to a primary health care facility for individuals with established risk factors, and active follow-up to evaluate self-care adherence. Weight, body mass index (BMI), waist circumference, and waist-hip ratio were measured at baseline, 2^nd year, and 4^th years, then all measured parameters were statically compared.

Results: In total, 1500 adolescents with central obesity from 800 families with a positive family history of cardiovascular risk were comparable in mean age, and male to female ratio. In addition, attrition rate at the 2^nd year follow-up was 5%. The adjusted population average change attributable to the intervention at the 4^th year follow-up were -2.99 kg in weight (95% CI, (-3.02 to -2.96; P <.001), -0.91 kg/m² in BMI (95% CI, -0.9 to -0.92), -4.3 cm in waist circumference (95% CI, -5.34 to -3.26), and -4.29 cm in waist-hip ratio (95% CI, -4.46 to -4.27).