A behavior-focused lifestyle program that encourages simple habits and has immediate benefits may help maintain remission of metabolic syndrome (MetS) after treatment, according to findings from the ELM randomized clinical trial, presented at AHA 2025 and simultaneously published Nov. 9 in JAMA Internal Medicine.

Lynda H. Powell, PhD, et al., randomized 618 participants (mean age, 55 years; 75% women; 83% with obesity) with MetS (defined as three or more cardiometabolic risk factors) to the intervention (n=306) or comparator (n=312) group. Both groups received education and an activity monitor, and the lifestyle intervention included 19 small group sessions over six months focused on healthy habit formation.

Results at six months showed that MetS remissions were higher in the intervention vs. comparator group (25% vs. 18%; adjusted odds ratio [OR], 1.64; 95% CI, 1.07-2.53; p=0.03).

Additionally, the intervention was superior for a number of outcomes, including clinical outcomes (waist circumference, triglycerides, fasting glucose, BMI, weight, hemoglobin A1c and MetS severity), quality of life outcomes, lifestyle targets of intervention (vegetable intake, moderate-intensity physical activity, daily steps, sensory awareness), and automatic habits (daily brisk walks and vegetables at meals).

Findings also revealed that at 24 months, MetS remissions were higher in the intervention (28%) than the comparator (21%) group (adjusted OR, 1.46; 95% CI, 1.01-2.14; p<0.05), with sustained improvements in fasting glucose, vegetable intake, daily steps, sensory awareness and the habit of daily brisk walks.

The authors note, "The most convincing support for lifestyle change was in daily steps." Participants in the intervention walked an average of 4,823 daily steps vs. 4,158 steps in the comparator group.

No safety concerns or adverse events related to trial participation were reported.

Powell and colleagues write that "targeting lifestyle alone may limit the potential strength of an intervention for MetS" and suggest that GLP-1 obesity drugs, which reduce caloric intake, "act in synergy with lifestyle interventions." They find it "compelling to consider the success and cost-effectiveness that could result from combining a drug that works while on treatment with a lifestyle intervention that works after treatment is discontinued."