Eating competence trajectories of persons with metabolic syndrome over two years: A secondary analysis of the ELM lifestyle intervention.

Eating competence (EatC) is an approach to eating that aligns with health outcomes also targeted in remission of metabolic syndrome (MetS). This study examined change in EatC and the relationship to MetS status and psychosocial characteristics. This is a secondary analysis of biopsychosocial data collected during The Enhancing Lifestyles for Metabolic Syndrome (MetS) trial, a randomized controlled trial that aimed for MetS remission over a 6-month lifestyle-intensive intervention and 18-month follow-up. The repeated measures analysis compared habit-based intensive intervention (n = 227) and education comparator (n = 239) EatC trajectories and examined biopsychosocial correlates of EatC change. Eligible participants (n = 466) completed four clinical trial measurement cycles. EatC significantly increased over the two-year period (30.1 ± 0.3 to 32.1 ± 0.4; P < 0.001) and when controlling for most biopsychosocial factors, but not for stress or BMI. Baseline to six-month to end of trial trajectories differed by treatment group (P = 0.006). with greater gains by six months but maintained to end of trial for the intervention (29.7 ± 0.5 to 32.0 ± 0.5 to 32.0 ± 0.5, respectively). The comparator trajectory of gains was more gradual, (30.5 ± 0.5 to 31.3 ± 0.5 to 32.2 ± 0.5). Changes in biopsychosocial measures (e.g. mindfulness, stress, physical activity habit) were significantly correlated, in a healthful direction, with EatC change. EatC improvement was significantly greater for persons with MetS remission at the end of the trial. MetS severity index decreased more for those whose EatC score increased and for those randomized to the intervention. Each treatment arm demonstrated at least 30% congruence with EatC tenets. Findings demonstrated EatC improvement over time, in tandem with a remission of the MetS and suggest explicit inclusion of EatC attributes in lifestyle program development.