ArticleScientific reports2025
A COM-B-guided lifestyle intervention reduces metabolic syndrome in overweight and obese adolescents: a multiphase study in Vietnam.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Metabolic syndrome (MetS) among adolescents with overweight/obesity (OW/OB) is rising rapidly in low- and middle-income countries (LMICs), yet evidence on theory-driven behavioral interventions remains limited. To estimate the prevalence and risk factors of MetS in Vietnamese adolescents aged 11-14 years with OW/OB, and to evaluate the effectiveness of a 12-month lifestyle intervention grounded in the COM-B model. We conducted a three-phase study: (1) a province-wide cross-sectional survey to determine MetS prevalence; (2) a matched case-control study to identify risk factors; and (3) a school-based COM-B intervention comprising health education, environmental modifications, and motivation enhancement. Adherence was quantified using a six-point scale and categorized as high (≥ 75%), moderate (40-<75%), or low (< 40%). The primary outcome was MetS resolution at 12 months according to International Diabetes Federation (IDF) pediatric criteria; secondary outcomes included anthropometric, biochemical, and behavioral changes. Of 6,009 students screened, 2,055 (34.2%) had OW/OB, among whom 628 (30.6%; 95% CI, 28.6-32.6) had MetS, with hypertriglyceridemia (87.9%) and low HDL-C (84.4%) being most prevalent. Waist-to-height ratio ≥ 0.46 was the strongest independent risk factor (OR = 2.96; 95% CI: 1.76-5.00), while exclusive breastfeeding for 6 months was protective (OR = 0.45; 95% CI: 0.35-0.58). A 12-month COM-B-guided lifestyle intervention in 300 OW/OB adolescents with MetS achieved a 71.7% resolution rate (95% CI: 66.2-76.7), with significant improvements in metabolic parameters (triglycerides - 0.41 mmol/L, HDL-C + 0.12 mmol/L, CAP - 29.6 dB/m; all p < 0.001) and health behaviors (sugar-sweetened beverage intake - 4.7 times/week, screen time - 3.6 h/day). High adherence was associated with the greatest cardiometabolic and behavioral gains, supporting a dose-response relationship consistent with the COM-B framework. A school-based COM-B intervention substantially improved MetS and health behaviors among adolescents with OW/OB, with effectiveness varying by adherence level. The model appears feasible and scalable in LMIC settings, although longer-term follow-up is needed to assess sustainability.
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