1. Prepare the Meatball Mixture: In a large bowl, combine ground chicken, pumpkin purée, breadcrumbs, egg, minced garlic, onion powder, salt, and black pepper. Mix gently until just combined.

2. Shape the Meatballs: Wet your hands slightly and shape the mixture into approximately 16 meatballs, each about 1½ inches in diameter. If the mixture feels too sticky, refrigerate for 15–20 minutes.

3. Brown the Meatballs: Heat olive oil in a large skillet over medium heat. Add the meatballs and cook for 2–3 minutes per side until golden brown. Work in batches if necessary.

4. Prepare the Sage Cream Sauce: In a separate saucepan, melt butter over medium heat. Add chopped fresh sage and cook for 30 seconds until fragrant.

5. Add the Cream: Pour in heavy cream, season with salt and pepper, and stir gently. Reduce heat and simmer for 3–4 minutes until slightly thickened.

6. Combine Meatballs and Sauce: Transfer the browned meatballs to the sage cream sauce. Cover and simmer gently for 5–7 minutes, or until the internal temperature reaches 165°F (74°C).

7. Garnish and Serve: Spoon the creamy sage sauce over the meatballs. Garnish with fresh sage leaves and cracked black pepper. Serve warm with mashed potatoes, pasta, or rice.