Beyond Single-Setting Care: A Hub-and-Spoke Multisectoral Model for Metabolic Syndrome Prevention Integrating Lifestyle, Digital, and Policy Interventions
DOI :
https://doi.org/10.62255/mjhp.v4iSuppl%201.322Abstract
Background: Metabolic syndrome requires sustained multisectoral interventions, yet single-setting clinical approaches often fail to maintain long-term behavioral adherence and biomarker improvements, particularly for lipid and glycemic markers.
Objective: To synthesize cross-sectoral evidence and propose a scalable, integrated prevention model addressing both clinical and environmental determinants of cardiometabolic risk.
Methods: A comprehensive synthesis of randomized trials, quasi-experiments, pragmatic studies, and meta-analyses spanning primary care, workplace, community, school, digital-health, and policy contexts.
Results: Multicomponent lifestyle programs combining diet, physical activity, and structured coaching consistently reduce waist circumference, blood pressure, and BMI, while variably improving fasting glucose and lipids. Community and workplace settings prove vital for reaching underserved populations. While digital tools enhance scalability, they require human support to sustain long-term gains. Consequently, a "hub-and-spoke" architecture emerged: primary care as the risk-identification hub, linked to community and workplace spokes for sustained behavioral delivery, reinforced by digital tools and upstream environmental policies.
Conclusion: Multisectoral health promotion effectively prevents metabolic syndrome when structured as a coordinated hub-and-spoke system. Prioritizing human-supported, culturally tailored behavioral interventions across integrated sectors yields the most scalable and equitable long-term cardiometabolic benefits.
Downloads
Keywords
References
Bergum, H., Sandven, I., & Klemsdal, T. (2021). Long-term effects (> 24 months) of multiple lifestyle intervention on major cardiovascular risk factors among high-risk subjects: a meta-analysis. BMC Cardiovascular Disorders, 21. https://doi.org/10.1186/s12872-021-01989-5
Bertini, A., Bahamondes, M., Rojas, J., Puebla, P., Rodriguez, S., & Quijada, J. (2026). Telemedicine and Digital Health Interventions for the Management of Metabolic Syndrome: A Systematic Review of Clinical Outcomes. Telemedicine and E-Health, 32, 771–784. https://doi.org/10.1177/15305627261443161
Bogale, S. K., Sarma, H., Alamnia, T., & Kelly, M. (2024). Workplace?Based Education Interventions for Managing Metabolic Syndrome in Low? and Middle?Income Countries: A Realist Review. Public Health Challenges, 3. https://doi.org/10.1002/puh2.224
Bulthuis, S., Kok, M., Raven, J., & Dieleman, M. (2019). Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative systematic literature review. Health Policy and Planning, 35, 219–234. https://doi.org/10.1093/heapol/czz140
Caballero, P., Wanden-Berghe, C., Sanz-Lorente, M., & López-Pintor, E. (2021). Effectiveness of Workplace-Based Diet and Lifestyle Interventions on Risk Factors in Workers with Metabolic Syndrome: A Systematic Review, Meta-Analysis and Meta-Regression. Nutrients, 13. https://doi.org/10.3390/nu13124560
Chan, B., Li, P. -w. -c., & Yu, D. -s. -f. (2026). Digital lifestyle re-engineering with maintenance phase design: The TOP-S randomised clinical trial in metabolic syndrome management. European Journal of Preventive Cardiology. https://doi.org/10.1093/eurjpc/zwag249.282
Commodore-Mensah, Y., Chen, Y., Ogungbe, O., Liu, X., Metlock, F., Carson, K., Echouffo?Tcheugui, J., Ibe, C., Crews, D., Cooper, L., & Himmelfarb, C. (2024). Design and Rationale of the Cardiometabolic Health Program Linked with Community Health Workers and Mobile Health Telemonitoring to Reduce Health DisparitieS (LINKED-HEARTS) Program. American Heart Journal, 275, 9–20. https://doi.org/10.1016/j.ahj.2024.05.008
Cowie, J., Nicoll, A., Dimova, E., Campbell, P., & Duncan, E. (2020). The barriers and facilitators influencing the sustainability of hospital-based interventions: a systematic review. BMC Health Services Research, 20. https://doi.org/10.1186/s12913-020-05434-9
Hamdy, O., Mottalib, A., Morsi, A., El-Sayed, N., Goebel-Fabbri, A., Arathuzik, G., Shahar, J., Kirpitch, A., & Zrebiec, J. (2017). Long-term effect of intensive lifestyle intervention on cardiovascular risk factors in patients with diabetes in real-world clinical practice: a 5-year longitudinal study. BMJ Open Diabetes Research & Care, 5. https://doi.org/10.1136/bmjdrc-2016-000259
Hassett, L., Moseley, A., Nettlefold, L., Pearce, L., Franke, T., Macdonald, H., Tiedemann, A., & McKay, H. (2025). Building readiness in community-based organisations to enable the implementation of public health interventions for adults and older adults: a scoping review. BMC Public Health, 26. https://doi.org/10.1186/s12889-025-25745-y
Höchsmann, C., Dorling, J., Martin, C., Newton, R., Apolzan, J., Myers, C., Denstel, K., Mire, E., Johnson, W., Zhang, D.-C., Arnold, C., Davis, T., Fonseca, V., Lavie, C., Price-Haywood, E., & Katzmarzyk, P. (2021). Effects of a Two-Year Primary Care Lifestyle Intervention on Cardiometabolic Risk Factors – A Cluster-Randomized Trial. Circulation, 143, 1202–1214. https://doi.org/10.1161/circulationaha.120.051328
Howell, N., & Booth, G. (2022). The weight of place: Built environment correlates of obesity and diabetes. Endocrine Reviews. https://doi.org/10.1210/endrev/bnac005
Jancey, J., Lee, A., James, A., Howat, P., Hills, A., Anderson, A., Tran, V., & Blackford, K. (2020). Long?term sustainability of a physical activity and nutrition intervention for rural adults with or at risk of metabolic syndrome. Australian and New Zealand Journal of Public Health, 44. https://doi.org/10.1111/1753-6405.13036
Jang, M., Park, J.-H., Lee, J.-G., Yi, Y., Lee, S.-H., Kim, G., Ra, Y., Shin, M.-J., & Tak, Y. J. (2026). Efficacy of telephone-based health counseling with wearable device-Smartphone monitoring in older adults with metabolic syndrome: A randomized controlled trial. Archives of Gerontology and Geriatrics, 147, 106232. https://doi.org/10.1016/j.archger.2026.106232
Joseph, M., Konerman, M., Zhang, M., Wei, B., Brinza, E., Walden, P., Jackson, E., & Rubenfire, M. (2018). Long-term outcomes following completion of a structured nutrition and exercise lifestyle intervention program for patients with metabolic syndrome. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 11, 753–759. https://doi.org/10.2147/dmso.s175858
Kalter-Leibovici, O., Younis-Zeidan, N., Murad, H., Kimron, L., & Chetrit, A. (2026). Long-term cardio-metabolic effects of lifestyle intervention among obese Arab women: a 12-year follow-up of a randomized trial. Frontiers in Endocrinology, 17. https://doi.org/10.3389/fendo.2026.1786705
Kalter-Leibovici, O., Zeidan, N., Murad, H., & Chetrit, A. (2025). Long-term effect of intensive lifestyle intervention among obese arab women: a cohort study. European Journal of Preventive Cardiology. https://doi.org/10.1093/eurjpc/zwaf236.271
Kelly, C., Da Rosa, P., Remmele, J., Tilenbaeva, N., Arnold, R., Oberhoffer-Fritz, R., Fonseca, H., Buoncristiano, M., Wickramasinghe, K., & Williams, J. (2025). Inequalities in childhood overweight and obesity: A call to strengthen upstream policy measures. Public Health in Practice, 10. https://doi.org/10.1016/j.puhip.2025.100637
Koeder, C., Kranz, R.-M., Anand, C., Husain, S., Alzughayyar, D., Schoch, N., Hahn, A., & Englert, H. (2021). Effect of a 1-Year Controlled Lifestyle Intervention on Body Weight and Other Risk Markers (the Healthy Lifestyle Community Programme, Cohort 2). Obesity Facts, 15, 228–239. https://doi.org/10.1159/000521164
Kouidis, I.-A., Deligiannis, P., Theofanous, A., Anifanti, M., & Kouidi, E. (2026). Technology-Enhanced Exercise Training for Cardiometabolic Syndrome: A Scoping Review. Journal of Functional Morphology and Kinesiology, 11. https://doi.org/10.3390/jfmk11020153
Kumanyika, S. (2019). A Framework for Increasing Equity Impact in Obesity Prevention. American Journal of Public Health. https://doi.org/10.2105/ajph.2019.305221
Laddu, D., Jun, Kaar, J., Ozemek, C., Durant, R., Campbell, T., Welsh, J., & Turrise, S. (2021). Health Behavior Change Programs in Primary Care and Community Practices for Cardiovascular Disease Prevention and Risk Factor Management Among Midlife and Older Adults. Circulation, 144. https://doi.org/10.1161/cir.0000000000001026
Lee, J., Lee, K., Kim, H., Youk, H., & Lee, H.-Y. (2022). Effective Prevention and Management Tools for Metabolic Syndrome Based on Digital Health-Based Lifestyle Interventions Using Healthcare Devices. Diagnostics, 12. https://doi.org/10.3390/diagnostics12071730
Lu, Y., Hu, B., Xu, Y., Na, N., Cao, S., & Zhu, X.-L. (2026). Efficacy of digital coaching-based diet and exercise interventions on metabolic syndrome: A comprehensive meta-analysis. International Journal of Nursing Studies, 179, 105545. https://doi.org/10.1016/j.ijnurstu.2026.105545
McCart, A., McCart, D., & Parks, A. (2026). Choice Architecture at Scale: Reimagining the Built Environment as a Population Health Intervention. International Journal of Research and Innovation in Social Science. https://doi.org/10.47772/ijriss.2026.100601385
McCreight, M., Rabin, B., Glasgow, R., Ayele, R., Leonard, C., Gilmartin, H., Frank, J., Hess, P., Burke, R., & Battaglia, C. (2019). Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs. Translational Behavioral Medicine. https://doi.org/10.1093/tbm/ibz085
Meir, A. Y., Tsaban, G., Rinott, E., Zelicha, H., Schwarzfuchs, D., Gepner, Y., Rudich, A., Shelef, I., Blüher, M., Stumvoll, M., Ceglarek, U., Isermann, B., Klöting, N., Keller, M., Kovacs, P., Qi, L., Wang, D., Liang, L., Hu, F., … Shai, I. (2025). Individual response to lifestyle interventions: a pooled analysis of three long-term weight loss trials. European Journal of Preventive Cardiology. https://doi.org/10.1093/eurjpc/zwaf308
Moore, T., Neergaard, R., Hennessy, E., Calancie, L., Economos, C., & Kumanyika, S. (2026). Identifying Synergistic Mechanisms of Community-Led Policy, Systems, and Environmental Change for Childhood Obesity Prevention in the Multi-Site Catalyzing Communities Initiative. Journal of Urban Health?: Bulletin of the New York Academy of Medicine, 103, 77–91. https://doi.org/10.1007/s11524-025-01046-y
Powell, L., Berkley-Patton, J., Drees, B., Karavolos, K., Lohse, B., Masters, K., Nicklas, J., Rothschild, S., Yeh, C., Zimmermann, L., & Suzuki, S. (2025). Lifestyle Intervention for Sustained Remission of Metabolic Syndrome. JAMA Internal Medicine, 186, 67–77. https://doi.org/10.1001/jamainternmed.2025.5900
Sun, L., Booth, A., & Sworn, K. (2024). Adaptability, Scalability and Sustainability (ASaS) of complex health interventions: a systematic review of theories, models and frameworks. Implementation Science?: IS, 19. https://doi.org/10.1186/s13012-024-01375-7
Suwannawong, P., Auemaneekul, N., Powwattana, A., & Chongsuwat, R. (2023). Ecological system theory and community participation to promote healthy food environments for obesity and non-communicable diseases prevention among school-age children. Public Health Nutrition, 26, 1488–1500. https://doi.org/10.1017/s136898002300040x
Tesfay, N., Olsson, T., Jakobsson, T., Nilsson, P., & Skoog, T. (2026). Systematic Review of Organizational Strategies to Promote the Sustainability and Scale-Up of Mental Health Interventions to Advance Youth Psychological Wellbeing. Prevention Science, 27, 234–249. https://doi.org/10.1007/s11121-025-01874-z
Tomah, S., Zhang, H., Al-Badri, M., Salah, T., Dhaver, S., Khater, A., Tasabehji, M. W., & Hamdy, O. (2023). Long-term effect of intensive lifestyle intervention on cardiometabolic risk factors and microvascular complications in patients with diabetes in real-world clinical practice: a 10-year longitudinal study. BMJ Open Diabetes Research & Care, 11. https://doi.org/10.1136/bmjdrc-2022-003179
Van Dijk, M., Loo, L. Te, Vrijsen, J., Van Den Akker-Scheek, I., Westerveld, S., Annema, M., Van Beek, A., Van Den Berg, J., Boerboom, A., Bouma, A., De Bruijne, M., Crasborn, J., Van Dongen, J., Driessen, A., Eijkelenkamp, K., Goelema, N., Holla, J., De Jong, J., De Joode, A., … Jelsma, J. (2023). LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change—study protocol. Trials, 24. https://doi.org/10.1186/s13063-022-06960-z
Yu, B., Li, Y.-C., Chunlan, Reinhardt, J., Dou, Q.-Y., Zuo, H., Yang, X., Li, M., Cai, C.-W., Fan, Y., Huang, Z., Pang, T., Tang, Q., Yang, F., Ye, T., Jia, P., & Yang, S.-J. (2025). Effectiveness of socioecological model-guided, smart device-based, and self-management-oriented lifestyle (3SLIFE) intervention on healthy lifestyles and metabolic syndrome risk in community residents: a cluster-randomized controlled trial. BMC Medicine, 23. https://doi.org/10.1186/s12916-025-04135-6
Yu, B., Tang, Q.-C., Hu, Y., Zuo, H., Yang, B., Pan, J., Jia, P., Reinhardt, J., & Yang, S.-J. (2026). mHealth-based Healthy Lifestyle Promotion (MYLIFE) for metabolic syndrome risk reduction in Chinese employed adults: protocol for a cluster-randomised controlled trial. BMJ Open, 16. https://doi.org/10.1136/bmjopen-2025-109980
Zhu, R.-X., Guo, J., Huttunen-Lenz, M., Stratton, G., Swindell, N., Macdonald, I., Handjieva-Darlenska, T., Handjiev, S., Navas-Carretero, S., Poppitt, S., Silvestre, M., Schlicht, W., Fogelholm, M., Martinez, J., Raben, A., & Brand-Miller, J. (2026). Enduring improvements in hepatic insulin sensitivity predict sustained remission of prediabetes during a 3-year lifestyle intervention: results from the PREVIEW multinational diabetes prevention trial. Metabolism: Clinical and Experimental, 156546. https://doi.org/10.1016/j.metabol.2026.156546
Zimmermann, S., Vogel, M., Mathew, A., Ebert, T., Rana, R., Jiang, S.-H., Isermann, B., & Biemann, R. (2022). The Extent of Lifestyle-Induced Weight Loss Determines the Risk of Prediabetes and Metabolic Syndrome Recurrence during a 5-Year Follow-Up. Nutrients, 14. https://doi.org/10.3390/nu14153060
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2026 Andini Kurniawati, Akifah Hanin Najwa Sajidah, Moch. Yunus, Karina Nilasari, Ilham Akbar Hardiansyah
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License .
You are free to:
• Share — copy and redistribute the material in any medium or format.
• Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Under the following terms:
• Attribution — You must give appropriate credit to the original author(s) and Health Frontiers, provide a link to the license, and indicate if changes were made.
• ShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.
