Habit-Based Lifestyle Intervention Improves Long-Term Metabolic Syndrome Remission in US Adults
Key Highlights
- A habit-based lifestyle intervention increased 24-month metabolic syndrome remission (27.8% vs 21.2%; adjusted OR 1.46).
- Improvements were sustained in fasting glucose, daily steps, and vegetable intake.
- The intervention emphasized simple, repeatable habits such as brisk walking and vegetable consumption.
- No safety concerns were identified, and participant satisfaction was higher in the intervention group.
A randomized clinical trial published in JAMA Internal Medicine examined whether a structured, habit-based lifestyle intervention could improve long-term remission of metabolic syndrome (MetS). The study found that adding a 6-month behavioral program to standard education and activity monitoring modestly increased sustained remission rates at 24 months compared with education and monitoring alone.
The Enhancing Lifestyles in Metabolic Syndrome (ELM) trial enrolled 618 adults with MetS across five US sites between 2019 and 2022. Participants were randomized to either a lifestyle intervention group or a comparator group. Both groups received educational materials and a Fitbit activity monitor. The intervention group additionally participated in 19 in-person group sessions over 6 months focused on establishing four core habits: eating vegetables at meals, engaging in daily brisk walking, practicing sensory awareness, and improving emotion regulation. Participants were followed for 24 months, with the primary outcome defined as remission of MetS based on blinded clinical and laboratory assessments.
Study Findings
At 6 months, MetS remission occurred in 24.8% of the intervention group compared with 17.9% of the comparator group (aOR, 1.64; 95% CI, 1.07-2.53; P = .03). At 24 months, sustained remission was observed in 27.8% of intervention participants versus 21.2% in the comparator group (aOR, 1.46; 95% CI, 1.01-2.14; P < .05). Approximately 15 patients would need to receive the intervention for one additional remission.
Secondary outcomes showed that at 6 months, the intervention improved multiple cardiometabolic markers, including waist circumference, triglycerides, fasting glucose, body mass index, and hemoglobin A1c. By 24 months, sustained differences between groups were primarily seen in fasting glucose levels (97.7 vs 100.7 mg/dL; P = .04). Lifestyle changes persisted, including higher vegetable intake (4.0 vs 3.4 servings/day), greater daily steps (4822.6 vs 4157.8), and improved sensory awareness.
Clinical Implications
According to the study authors, the findings suggest that promoting simple, repeatable habits may support sustained remission of metabolic syndrome even after active intervention ends. The results indicate that focusing on immediate benefits and habit formation may enhance long-term adherence to lifestyle changes.
The study had several limitations. The treatment effect was modest with a wide confidence interval, and differences in intervention intensity may have introduced nonspecific effects. Additionally, COVID-19–related disruptions may have diluted the intervention’s impact, and implementation of intensive in-person programs may be challenging and potentially not cost-effective.
Expert Commentary
“It is 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,” the research authors concluded. “At a more basic level, changes in the socioecological systems associated with MetS are needed. However, until these basic changes are made, the prevalence of MetS continues to rise and evidence-based interventions are needed urgently.”
Reference
Powell LH, Berkley-Patton J, Drees BM, et al; ELM Trial Research Group. Lifestyle intervention for sustained remission of metabolic syndrome: a randomized clinical trial. JAMA Intern Med. 2026;186(1):67-77. doi:10.1001/jamainternmed.2025.5900