Metabolic Syndrome and Abdominal Obesity: Waist Measurement and Lifestyle Education to Reduce Cardiovascular and Diabetes Risk

The overall aim was to contribute to the development of effective self-management lifestyle education for management of cardiovascular and diabetes risk in people with metabolic syndrome (MetS). An additional aim was to elicit views on the use of waist circumference measurement to assess health risk due to overweight and obesity, and identify strategies to promote waist measurement. A qualitative study was conducted to determine the knowledge and attitudes of patients and primary care health practitioners concerning waist size measurement. A systematic review (and meta-analysis) was conducted to review the existing evidence on effectiveness of interventions for reducing diabetes and cardiovascular risk in people with MetS. An evidence based group lifestyle education programme was developed and tested in a randomised controlled trial: The Reversal Intervention for Metabolic Syndrome (TRIMS) study. Key findings: -Healthcare professionals were generally aware of a link between a large waist size and health risks; practical barriers to using waist measurement included lack of time, extra workload and financial implications. For patients, being given an explanation of the assessment appeared to be what was most important to them. -The benefits of both lifestyle and pharmacological interventions to reverse MetS were indicated, by the meta-analysis, with lifestyle being the most effective. -The TRIMS education programme was well received; people felt positive about making lifestyle changes and improving their future health. -After 6-months follow-up the TRIMS programme was effective at reducing waist size, hip circumference, weight, and body mass index, and increasing unsaturated fat intake; reversal of MetS was not significantly different between the intervention and control groups. Based on the findings from this programme of work, recommendations are provided for future research and clinical practice in order to promote better management of cardiovascular and diabetes risk in people with MetS.