During the past 4 decades, the prevalence of obesity in the United States has increased dramatically. If these trends continue, 83% of adults will be overweight or obese by 2030 (1). Obesity is associated with various conditions (dyslipidemia, elevated blood pressure, and insulin resistance or glucose intolerance) that collectively are known as metabolic syndrome, which affects 50 to 75 million Americans (1,2).

Nutrition and physical activity are key lifestyle factors that affect the incidence of obesity, metabolic syndrome, and other diseases. Even modest weight loss improves dyslipidemia, insulin resistance, and estimated 10-year cardiovascular disease risk (3-7). Millions of Americans enroll in weight loss programs each year, but few such programs have been clinically tested. When they are tested, results generally show poor efficacy and adherence (8). Weight Watchers is the only weight loss program that has been tested extensively; it results in a mean loss of approximately 5% of initial weight in 3 to 6 months, but 70% of participants stop attending within 12 weeks (8).

Because wellness programs can reduce the cost of health care and generate a substantial return on investment (savings of $1.49 to $4.91 in health care costs per dollar spent on wellness) (9), programs are needed that focus on weight loss, metabolic syndrome, chronic disease prevention, and emotional well-being. Our goal was to determine whether a multifaceted diet and exercise program could result in weight loss and decrease insulin resistance, reduce risk for metabolic syndrome, and increase overall wellness in overweight and obese adults. The program was conducted in a church setting to foster motivation, accountability, and social support. We examined physical, biochemical, and psychological endpoints to assess the effect of the program on obesity and several comorbidities.

Of 46 overweight or obese participants who began the program, 41 (27 women and 14 men) completed it. Participants' mean age was 53 years (range, 35-74 years), and all participants were white with the exception of 1 female African American participant. At baseline, all participants exceeded the healthy cutoff value for percentage of body fat (≤31% for women and ≤21% for men); 17 women and 13 men also exceeded the healthy cutoff value for waist-to-hip ratio (≤0.8 for women and ≤0.9 for men). Eighteen participants completed a medical history, and of these, 12 reported immunologic conditions (such as allergy, asthma, arthritis, or atopic dermatitis), 8 reported cardiovascular disease (such as high blood pressure or history of heart attack), 5 reported high cholesterol, and 2 reported diabetes.

During the 8-week intervention, men lost an average of 5.9 kg (13.1 lb) and women lost an average of 4.8 kg (10.5 lb), which is approximately a 6% decrease in body weight for both men and women (Figure). After the intervention, the participants' weights were stable for 5 weeks; at 10 weeks, women's weight remained stable but men began to regain weight.

Similarly, body fat and BMI decreased in both men and women during the 8 weeks of the program. In women, these trends continued during the 10-week follow-up. In men, body fat remained stable during the follow-up period, but BMI began to increase after 5 weeks (Figure). Waist circumference, hip circumference, and waist-to-hip ratio also significantly decreased in both women and men during the intervention. By the end of the intervention, 6 overweight participants (4 women, 2 men) had moved into the healthy-weight BMI range, and 1 obese participant had moved into the overweight BMI range.

Twenty-seven participants (17 women, 10 men) turned in complete wellness questionnaires at both baseline and 8 weeks. Participants reported significant improvements in most domains (Table 1).

After the intervention, waist circumference, a measure of central adiposity, was significantly decreased in women and men, and systolic blood pressure was significantly decreased in men (Table 2). Most other risk factors for metabolic syndrome improved, but the differences did not reach significance. The average number of metabolic syndrome risk factors, however, did significantly decrease for women (from 2.0 to 1.6, P = .02) and men (from 2.5 to 1.5, P < .001). At baseline, 18 of 41 participants were classified as having metabolic syndrome (10 women and 8 men). After the intervention, that number had decreased to 10 (6 women and 4 men) (P < .001).

Although fasting glucose levels did not change (Table 2), all other markers of insulin resistance decreased in both women and men by the end of the intervention (Table 3).

This multifaceted intervention significantly improved the conditions that define metabolic syndrome and reduced the number of participants who had metabolic syndrome. We also found improvements in several measures of insulin resistance. These observations suggest that a multifaceted approach to wellness that incorporates nutrition education and exercise in a supportive, faith-based environment can promote healthy lifestyle changes in overweight and obese adults.

Our findings contrast with results of several commercial weight loss programs, which have high attrition rates, rapid weight regain, and poor adherence (8). More than 90% of our participants finished the 8-week intervention, and on average, women in our study continued to lose weight 10 weeks after the end of the program. Feedback indicated that reasons for adherence included the emphasis on behavioral modifications, realistic goals, information on how to meet goals, the hunger-curbing effects of fiber and water, regular group support and exercise, accountability to the group and its leaders, emphasis on disease management and prevention, use of diet and exercise logs, and the church setting where the group had common belief systems and tools.

Significant changes in indexes of metabolic syndrome and insulin resistance were achieved in a short time and in participants who lost only 6% to 8% of their original body weight and 9% to 13% of their original fat mass. This finding suggests that decreased fat mass is not the only factor responsible for the decreased insulin resistance. Whether the changes in metabolic syndrome were associated with those in insulin resistance is not clear. A recent study showed that metabolic syndrome is a significant predictor of diabetes, increasing the risk by a factor of 3.5 to 5.2 (17); this association is significantly stronger than the association of metabolic syndrome with cardiovascular events (18).

Our intervention incorporated several dietary and exercise strategies. Consequently, determining the precise mechanisms responsible for the improvements is difficult. Several studies have found that exercise independently decreases glucose levels and risk of type 2 diabetes (19,20), and calorie restriction independently lowers insulin and triglyceride levels (19,21). In the CALERIE study, fasting insulin levels were significantly reduced from baseline at months 3 and 6 in both the calorie restriction group and the calorie restriction plus exercise group (19). The Diabetes Prevention Program showed that lifestyle changes, including exercise, for at least 2 years reduced the incidence of diabetes in high-risk populations (5).

The specific dietary recommendations in this study likely contributed to the observed improvements. A high-fiber diet, as recommended in this study, improves glycemic control (22,23), and adding long-chain omega-3 fatty acids to diets reduces risk of the components of metabolic syndrome (especially hyperlipidemia) and cardiovascular disease (24). Additionally, several studies indicate that adding polyphenols to diets decreases insulin resistance and reduces risk of metabolic syndrome (25-27). In our study, glucose regulation rapidly improved, most likely because the components of the intervention acted in an additive or synergistic manner.

This study has several limitations. First, the program was conducted at only 1 church, so the results cannot be generalized and the program may not be feasible in other settings. The efficacy of the program should be evaluated in groups that differ in age and ethnic and racial composition. Second, because of the multifaceted nature of the intervention, we cannot elucidate specific aspects that affected insulin resistance or metabolic syndrome. Third, physical and emotional wellness were assessed by self-report; however, self-perception of wellness is a complex sum of individual health values and social and environmental influences (28), all of which may vary among different ethnic and racial populations. Fourth, we did not include a control group, so we cannot say what changes would have occurred in people who did not undergo the intervention. Finally, our sample size was small and limits our power to detect smaller changes in some of the outcome measures.

In conclusion, we found that a multifaceted, church-based wellness program that emphasizes education, a healthy diet, weight loss, physical activity, weekly coaching, and accountability can rapidly (within 8 weeks) decrease insulin resistance and risk of metabolic syndrome.