Eligibility Details:
Inclusion Criteria:
1. Men and women with metabolic syndrome, defined by the Joint Interim Statement of the
IDF, NHLBI, AHA, WHF, IAS, IASO (Alberti, 2009). Note that hemoglobin A1c will be
measured as a marker of impaired glucose metabolism, but will not be considered in
determining metabolic syndrome status. To meet metabolic syndrome criteria the
participant should have ≥ 3 of the following five criteria:
- Waist circumference based on AHA/NHLBI (ATP III) cut points of ≥ 102 cm for men
and ≥ 88 cm for women
- Fasting triglycerides ≥150 mg/dL or treatment for elevated triglycerides
- Fasting HDL cholesterol <40 mg/dL in men or <50 mg/dL in women, or treatment for
low HDL
- Systolic blood pressure ≥130 m Hg, diastolic blood pressure ≥85 mm Hg, or
treatment for hypertension
- Fasting plasma glucose 100-125 mg/dL (range inclusive)
2. Age 18-80 years
Exclusion Criteria:
1. Unable to walk 2 consecutive blocks without assistance, based on patient report.
2. Unwilling, unable, or not ready to make the lifestyle changes prescribed in ELM
3. Unwilling to be randomized to either arm of the trial
4. Unable or unwilling to give an informed consent, communicate with study staff, or
complete the study run-in period. The run-in period requires attending an information
session, completing two assessment visits within the scheduled time (potential
participant is allowed to reschedule once), wearing an accelerometer, and completing
lifestyle logs (see protocol)
5. Does not have reliable access to the internet via a computer or mobile device
6. Not fluent in English
7. Current diagnosis of type 1 or type 2 diabetes, or on any diabetes medications except
metformin
8. Inpatient treatment for a psychiatric condition within the past 6 months, or currently
receiving treatment for schizophrenia or other serious psychiatric illness
9. Probable major depression, defined as a PHQ-8 score ≥10
10. Pregnant women, planning a pregnancy in the next 24 months, given birth in the last 6
months, or currently breastfeeding
11. ≥ 30 total days of oral corticosteroid use within the last year, history of solid
organ transplant, or history of stem cell transplant
12. Problematic use of alcohol and/or recreational drugs based on the ASSIST screening
tool (score of ≥27).
13. Self-reported or known history of an eating disorder (e.g., binging and purging) in
the past 5 years
14. Use of weight loss medications (Qsymia, phentermine, etc.) or supplements in the last
3 months, or unwilling to abstain from taking weight loss medications or supplements
during the study
15. History of bowel resection surgery or bariatric surgery
16. Participant does not have, or is unwilling to seek care from, a primary care physician
at the time of enrollment
17. Any medical condition known to influence the etiology of MetS as judged by the study
physician (e.g., uncontrolled hypothyroidism, endocrine hypertension, etc)
18. History of major cardiovascular illness, including a) stroke; b) myocardial
infarction; c) congestive heart failure requiring hospitalization, or greater than
NYHA heart failure class I; d) uncontrolled hypertension (SBP>180 or DBP > 105); e)
unstable angina; or f) other major cardiovascular illness which the site PI determines
could limit ability to participate in the trial.
19. Behavioral/logistical barriers to trial participation or engagement, e.g., a scheduled
major surgery, scheduling difficulties, travel plans, moving outside the study area
20. Cognitive impairment, defined by a Montreal Cognitive Assessment (MoCA) score of ≤25.
The MoCA will be administered only when research staff suspect cognitive impairment
21. Visual or hearing impairment
22. Severe food allergies or food intolerances/preferences that preclude participation in
the ELM program
23. Currently taking or expecting to take any of the following exclusionary medications:
1. Antiretroviral therapy (e.g., HAART)
2. Weight loss medications (as in #14)
3. Medications known to significantly influence weight or metabolic outcomes
4. Diabetes drugs other than metformin (as in #7)