Prevalence of metabolic syndrome (MetS) defined as 3 or more cardiometabolic risk factors has grown to 43% among US adults. Lifestyle interventions produce benefits, but with limited sustainability. To determine whether a 6-month habit-based lifestyle program adds benefit to education and activity monitoring for sustained MetS remission at 24 months. The Enhancing Lifestyles in Metabolic Syndrome (ELM) study was a single-blind, individually randomized clinical trial of participants with MetS recruited from July 2019 to January 2022 at 5 locations in the US and followed up for 24 months. Eligible participants were motivated for lifestyle change and were contacted using electronic medical records and social or mass media; those who did not meet medical or logistical criteria were excluded. In all, 14 817 adults were screened during a 2.5 year period. Data were analyzed from March 2024 to May 2025. All participants received education and an activity monitor. Those in the intervention group also received 19 small group in-person meetings during 6 months, which sought to establish the following habits as part of their daily routine: vegetables at meals, brisk walks, sensory awareness, and emotion regulation. Repetition of these habits was encouraged by attention to participants’ experience of immediate benefits and peer support. The comparator group received 24 evidence-based educational mailings monthly during the 24 months. MetS remission at 24 months determined by blinded laboratory evaluation and clinical examination. Secondary outcomes were cardiometabolic and lifestyle risk factors at 6 and 24 months. The analysis included 618 participants (mean [SD] age, 55.5 [11.0] years; 468 female [74.7%] and 150 male [24.3%] individuals), of whom 306 (49.5%) were randomized to the intervention and 312 (50.5%) to the comparator. The 24-month follow-up period was completed by 517 participants (83.7%). Obesity, measured by body mass index, was present in 513 participants (83%). At 6 months, the proportion achieving MetS remission was 24.8% in intervention group and 17.9% in comparator (adjusted odds ratio, 1.64; 95% CI, 1.07-2.53; P = .03), supported by improvements in waist circumference, triglycerides, fasting glucose, body mass index, weight, hemoglobin A 1c , MetS severity, perceived stress, vegetable intake, moderate-intensity physical activity, daily steps, sensory awareness, and the habits of daily brisk walks and vegetables at meals. At 24 months, the proportion achieving sustained MetS remission was 27.8% (85 of 306 participants) in intervention group and 21.2% (66 of 312) in the comparator (adjusted odds ratio, 1.46; 95% CI, 1.01-2.14; P < .05), supported by sustained improvement in fasting glucose, vegetable intake, daily steps, sensory awareness, and the habit of daily brisk walks. This randomized clinical trial found that sustained MetS remission after treatment may be possible by promoting simple habits through a behavior-based lifestyle program focused on immediate benefits. ClinicalTrials.gov Identifier: NCT04036006

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.

Background Eating competence (EatC) is a proxy for health that does not promote specific nutrients, foods, or portion sizes. Therefore, the study of the dietary quality of EatC has been limited and requires further investigation. One eating pattern structured for high dietary quality is the Mediterranean-DAH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet. The MIND diet is offered as a lifestyle strategy to maintain cognitive health and reduce dementia onset. Objective Compare MIND diet adherence and EatC level of healthy adults. Study Design, Setting, Participants An online survey was disseminated via US social media, key informants, and snowballing. Inclusion criteria were aged 30–60 years, English literate, independence in food choices and purchase decisions, and no eating disorder diagnosis within 5 years. Measurable Outcome/Analysis Eating competence was measured with the validated 16-item Eating Competence Satter Inventory (score range 0– 48); MIND diet adherence was assessed with the validated 15-item MIND diet screener (score range 0–15). Readiness for MIND diet adoption was measured with a Stage of Change tool developed for this study. Relationships were examined with Pearson correlation, inferential tests of mean difference, and chi-square. Results Respondents (mean age 44 ± 8.6 years) were predominantly female (76%), food secure (85%), college educated (69%), and without chronic disease (70%). Of 183 completers, 45% were EatC. Eating Competence Satter Inventory (mean 31.1 ± 8.1) was moderately positively correlated with the MIND diet screener (r = 0.41, P < 0.001). MIND diet screener was completed by 171; the score (mean 7.9 ± 2.4) was significantly higher in EatC vs non-Eat (8.7 ± 2.5 vs 7.3 ± 2.0, P < 0.001). Few respondents were interested in or following the MIND diet (n = 20); some were contemplative (n = 68), but most were unaware/not interested (n = 95). Eating Competence Satter Inventory scores differed across readiness categories, with the highest levels in interested/following compared with unaware/not Interested (35.6 ± 7.3 vs 29.5 ± 8.2; P = 0.008). Findings are limited by the homogeneous sample and limited inclusion in some staging categories. Conclusions Eating competence respondents had stronger adherence to the MIND diet, providing evidence that EatC is associated with higher dietary quality. Funding None

Concerns about weight gain are commonly cited with combined oral contraceptive pill (COCP) use, yet it remains unclear whether perceived weight gain as a reason for discontinuation differs by body mass index (BMI). We analyzed data from the 2017-2019 National Survey of Family Growth (NSFG), including 3709 non-pregnant women aged 20-49 years who had ever used COCPs and had BMI calculated from self-reported height and weight. Trained NSFG staff interviewed participants on reasons for discontinuation and coded them into predefined categories, including weight gain. Discontinuation was examined by BMI category (underweight, normal weight, overweight, obesity) using survey-weighted logistic regression adjusted for demographic and socioeconomic covariates. Overall, 35.2% (95% CI 32.3-38.1%) of women reported discontinuing COCPs due to dissatisfaction, with 20.2% (95% CI 18.1-22.3%) citing side effects. Weight gain was reported by 7.0% (95% CI 5.6-8.4%) of ever-users, with higher prevalence among women with overweight (8.4%) and obesity (7.7%) compared with normal-weight women (5.5%). In adjusted analyses, women with overweight (aOR 1.76, p = 0.048) and obesity (aOR 1.68, p = 0.033) had higher odds of COCP discontinuation due to self-reported weight gain. These findings highlight the importance of addressing weight-related concerns during contraceptive counseling, particularly for women with higher BMI.

Background Eating competence (EatC), a proxy for health, is measured with the Satter Eating Competence Inventory (ecSI 2.0). Global demand has increased translation requests; multicultural use challenges word/phrase selection. Objective Develop a graphic version of ecSI 2.0 for psychometric testing. Study Design, Setting, Participants Satter Eating Competence Inventory item data from 23 studies involving 17,844 scores from the US, Finland, and Brazil were compared with total ecSI 2.0 scores to select 8 items for graphical conversion. An agentic AI framework that combines LLM reasoning with DALL-E tool calls generated and refined graphical images for always and never/rarely response options, forming the ecSI_g. These graphics were entered into Qualtrics as visual analog scale anchors with slider movement denoting the level of anchor agreement. A University-wide email invited participants to complete an online survey including the ecSI 2.0, ecSI_g, and the Cohen’s Perceived Stress Scale. Measurable Outcome/Analysis Slider movement scores ranged from 4 to 0 with 0.1 intervals. To compare with ecSI 2.0 discrete scores, visual analog scale integer scores were coded (e.g., 2 - 2.9 =2). Correlations among summed scores from the ecSI 2.0, the selected ecSI 2.0 items, and the ecSI_g were controlled for stress and age. Results Of 492 accessing the survey, 316 completed the ecSI 2.0 and ecSI_g. The ecSI 2.0 and ecSI_g were normally distributed and internally consistent. Respondents were mostly female (73%), White (80%), not eating competent (57%), and highly stressed, with a mean age of 36.7 ± 14.9 years. Stress was inversely related to ecSI 2.0 (r = −0.48, P < 0.001) and ecSI_g scores (r = −0.37, P < 0.001); age was positively related to ecSI 2.0. The stress and age-controlled ecSI 2.0 score was significantly related to the ecSI_g score (r =0.47) and the sum of the selected 8 items (r = 0.94); the latter was related to the ecSI_g score (r = 0.48). All P < 0.001. Conclusions The ecSI_g performance supported further development and testing of a nontext measure of EatC. Generative artificial intelligence presents a novel opportunity to enable nontext-based eating behavior testing. Funding None

Importance:Prevalence of metabolic syndrome (MetS) defined as 3 or more cardiometabolic risk factors has grown to 43% among US adults. Lifestyle interventions produce benefits, but with limited sustainability. Objective:To determine whether a 6-month habit-based lifestyle program adds benefit to education and activity monitoring for sustained MetS remission at 24 months. Design, Setting, and Participants:The Enhancing Lifestyles in Metabolic Syndrome (ELM) study was a single-blind, individually randomized clinical trial of participants with MetS recruited from July 2019 to January 2022 at 5 locations in the US and followed up for 24 months. Eligible participants were motivated for lifestyle change and were contacted using electronic medical records and social or mass media; those who did not meet medical or logistical criteria were excluded. In all, 14 817 adults were screened during a 2.5 year period. Data were analyzed from March 2024 to May 2025. Interventions:All participants received education and an activity monitor. Those in the intervention group also received 19 small group in-person meetings during 6 months, which sought to establish the following habits as part of their daily routine: vegetables at meals, brisk walks, sensory awareness, and emotion regulation. Repetition of these habits was encouraged by attention to participants' experience of immediate benefits and peer support. The comparator group received 24 evidence-based educational mailings monthly during the 24 months. Main Outcome and Measures:MetS remission at 24 months determined by blinded laboratory evaluation and clinical examination. Secondary outcomes were cardiometabolic and lifestyle risk factors at 6 and 24 months. Results:The analysis included 618 participants (mean [SD] age, 55.5 [11.0] years; 468 female [74.7%] and 150 male [24.3%] individuals), of whom 306 (49.5%) were randomized to the intervention and 312 (50.5%) to the comparator. The 24-month follow-up period was completed by 517 participants (83.7%). Obesity, measured by body mass index, was present in 513 participants (83%). At 6 months, the proportion achieving MetS remission was 24.8% in intervention group and 17.9% in comparator (adjusted odds ratio, 1.64; 95% CI, 1.07-2.53; P = .03), supported by improvements in waist circumference, triglycerides, fasting glucose, body mass index, weight, hemoglobin A1c, MetS severity, perceived stress, vegetable intake, moderate-intensity physical activity, daily steps, sensory awareness, and the habits of daily brisk walks and vegetables at meals. At 24 months, the proportion achieving sustained MetS remission was 27.8% (85 of 306 participants) in intervention group and 21.2% (66 of 312) in the comparator (adjusted odds ratio, 1.46; 95% CI, 1.01-2.14; P < .05), supported by sustained improvement in fasting glucose, vegetable intake, daily steps, sensory awareness, and the habit of daily brisk walks. Conclusions and Relevance:This randomized clinical trial found that sustained MetS remission after treatment may be possible by promoting simple habits through a behavior-based lifestyle program focused on immediate benefits. Trial Registration:ClinicalTrials.gov Identifier: NCT04036006.

OBJECTIVES:To examine metabolic differences in women with or at risk of metabolic syndrome across 3 age groups used as a proxy for menopausal stages: premenopausal (PreM, <45 years), menopausal transition (PeriM 45-55 years), and postmenopausal (PostM, >55 years). METHODS:A total of 718 female subjects across 3 groups, PreM (n = 108, 15%), PeriM (n = 218, 30.4%), and PostM (n = 392, 54.6%), were included. Demographics, intakes of fruits, vegetables, and sugar-sweetened beverages, stress, and substance use were collected using self-reported surveys. Daily steps was assessed using accelerometers. Anthropometric (BMI, and waist circumference) and bioclinical data (blood pressure, fasting glucose, HbA1c, HDL cholesterol, and triglycerides) were measured using a standardized protocol. Analyses included Chi square, ANOVA, and Kruskal-Wallis tests appropriate to normality and variable structure. RESULTS:Lifestyle behaviors and metabolic characteristics differed by group with more negative health behaviors (diet, stress, substance use) and metabolic characteristics (BMI, waist circumference, and HDL) in PreM (P < 0.05). Compared to PreM, PeriM had lower BMI and higher HDL levels (both P < 0.05). Women in PostM group had the lowest stress, physical activity, and BMI but highest systolic BP, HbA1c, and HDL compared to the other 2 groups (P < 0.05). CONCLUSIONS:These results underscore the need for targeted menopausal stage-specific interventions to improve metabolic health and promote healthier lifestyle behaviors across the menopausal transition. Premenopausal women may benefit from early lifestyle and metabolic risk management, while peri- and postmenopausal women should prioritize maintaining physical activity and glycemic control.

Objective Examine the change in eating competence (EatC) over time in adults and children; explore the relationship between parent and child EatC. Design Survey assessment at 4 timepoints up to 6 years after baseline. Setting Elementary classroom and online survey. Participants Parent and child participants of the Fuel for Fun study. Adults (n = 406) were mostly female, White, and educated. Children (n = 296) were fourth graders, mostly White. Intervention For children, Fuel for Fun or control classrooms; for parents, About Eating, family-based activities, or no intervention. Variables Measured Eating competence, potential moderators (e.g., physical activity level, parent feeding strategy), or mediators (e.g., stress, body mass index, child fruit and vegetable preference). Analysis Linear mixed models with fixed effects for repeated measures. Bivariate and partial Pearson correlation coefficients. Results Eating competence tenets were affirmed, and EatC did not change over the measurement period for parents or children. For both parents and children, initial and final EatC measures were significantly correlated, but not between parents and their children. Conclusions and Implications Eating competence is a stable construct. Changing EatC may require a focused inclusion of Satter eating competence model tenets rather than information or activities that inhibit EatC (e.g., required tastings, pressure to eat fruit/vegetables, emphasis on weight loss).

Purpose:The prevalence of metabolic syndrome (MetS) continues to increase. The severity of MetS can be defined by the number of components or, more recently, a continuous MetS severity score (MetSSS). However, studies that examine lifestyle factors predictive of MetS severity, in general, are lacking. This study aims to compare lifestyle behaviors (eg, physical activity and diet), health perceptions (eg, overall and mental health perceptions), and psychosocial outcomes (eg, perceived stress and social support) among people with a varied number of MetS components and to evaluate associations with MetSSS. Patients and Methods:This cross-sectional study utilized baseline data from a randomized controlled trial of 618 participants with MetS recruited from 5 different sites across the US We collected data using accelerometers, standard questionnaires, bloodwork, and doing physical measurements. We used a series of separate linear regression models (unadjusted and adjusted) to evaluate differences in lifestyle behaviors, health perceptions, and psychosocial factors between people with 3, 4, and 5 MetS components. We conducted additional linear regression models (unadjusted and adjusted) to assess the association between these same variables and a continuous MetSSS. Results:Lifestyle behaviors, health perceptions, and psychosocial factors were not different among people with 3, 4, and 5 MetS components. However, in the adjusted models, a lower MetSSS was associated with more average daily steps (β = -631.69, p < 0.001), healthier overall health perception (β = -0.14, p = 0.014), more social support for physical activity from friends (β = -0.89, p = 0.011) and more social support for healthy eating from friends (β = -0.42, p = 0.015). Conclusion:The MetSSS was shown to be more sensitive to modifiable lifestyle factors compared to the number of MetS components, indicating the importance of using the MetSSS in lifestyle interventions targeting MetS to achieve MetS remission.

Disclosure: B. Nguyen: None. M. Godar: None. B. Lohse: None. B. Lisa: None. E. Ruder: None. J. Nicklas: Eli Lilly & Company, Novo Nordisk. P. Chilamkuri: None. M. Pratt: None. J. Berkley-Patton: None. L.H. Powell: None. B.M. Drees: Abbott Laboratories. Title: Metabolic Health Differences across the Menopausal Spectrum. Objectives: This study examined age-related metabolic differences in women (n=718) at risk of metabolic syndrome (MetS) across three menopausal stages: premenopausal (PreM, <45 years), menopausal transition (MenT, 45–55 years), and postmenopausal (PostM, >55 years). Methods: Demographic, anthropometric, dietary, tobacco, alcohol, recreational drug use, physical activity and bioclinical data were analyzed using Chi square tests (for categorical variables) and ANOVA tests for significant differences in group means among the age-based menopausal stages. Results: PreM group reported consuming fewer fruit and vegetable (p =0.03), had the highest perceived stress scores (p < 0.001), largest waist circumference (WC), and highest BMI. However, they had lowest levels of fasting glucose, HbA1c, and HDL cholesterol (p < 0.05) and were more likely to use tobacco and recreational drugs regularly (p < 0.05). In the MenT group, women reported less likely to use triglyceride medication (p = 0.012). They had significantly lower BMI and higher HDL cholesterol levels compared to the PreM group (p < 0.001), as well as having highest diastolic blood pressure (BP) among the three groups (p =0.036). The PostM group had the lowest perceived stress score (p<0.001), physical activity levels (p = 0.046), and BMI (p<0.001). However, they had the highest systolic BP, HbA1c levels, and HDL cholesterol (p < 0.05) and were more likely to use lipid and BP medications (p < 0.05). Across the menopausal stages, differences in relationship between metabolic outcomes and lifestyle factors were noticed. In the PreM group, BP was positively associated with tobacco use, glucose and HbA1c levels were negatively linked to alcohol, and recreational drug use and HDL cholesterol showed a negative relationship with perceived stress. Among the MenT group, physical activity was negatively associated with WC, while glucose levels were positively linked to both alcohol and recreational drug use. For individuals in the PostM group, triglyceride levels showed a positive association with tobacco use, while alcohol use was negatively associated with HbA1c and positively linked with elevated HDL cholesterol. Conclusions: These findings highlight the importance of tailoring interventions addressing lifestyle behaviors and metabolic health in women across the menopausal spectrum. Future research could explore mechanisms to explain the differences and the benefits of early intervention for long-term health outcomes. Presentation: Monday, July 14, 2025

Males are underrepresented in behavioral clinical trials of lifestyle. The aim of this exploratory study was to investigate factors associated with trial interest in males at different stages of recruitment and overall, into a multi-site behavioral trial targeting lifestyle change and remission of the metabolic syndrome. Similar analyses were performed for female participation to investigate the uniqueness or consistency with the findings for males. Data collected at various stages of recruitment in an ongoing multi-site behavioral clinical trial were used. A series of logistic regressions compared respondents who moved forward to the next step of the screening process versus those who did not. These analyses were stratified by sex. A chi-squared test was used to directly compare proportions of men and women who chose to advance to the next step. Males who showed interest in the trial were more likely to be self-aware of their current health risk. Comparison of males and females showed that men tended to lose interest earlier in the recruitment process (58.3 https://clinicaltrials.gov/study/NCT04036006

Parents’ feeding practices are a function of child eating behaviors, health, and other factors. Adherence to the Satter Division of Responsibility in Feeding (sDOR) model has not been examined relating to child BMI, household food security, or child eating behavior. This study evaluates the adherence to sDOR in relation to child eating behavior, nutrition risk, BMI-for-age, dietary intake, and food security. Ninety-one parent–child (3 to <6 years) dyads completed a cross-sectional asymmetric survey in August–November 2019; n = 69 parents from the original sample completed additional and retrospective questions in June 2021. Main outcomes included sDOR adherence (sDOR.2-6y™), a Child Eating Behavior Questionnaire (CEBQ), nutrition risk (NutriSTEP®), the USDA 6-item screener, the Block Kids Food Screener, and eating competence (ecSI 2.0™). The children’s weight and height were investigator-measured. Associations were tested with Pearson’s r and Chi Square for continuous and categorical variables, independent sample t-test, one-way ANOVA, or Mann–Whitney U compared means. The dietary comparisons used Spearman’s rho correlation coefficient. sDOR adherence was associated with a lower nutrition risk (r = 0.26, p = 0.03) and showed convergent validation with child eating behavior for three child eating behavior (CEBQ) constructs. sDOR.2-6y™ was not related to the child BMI-for-age z-score (r = 0.11, p = 0.39, n = 69). NutriSTEP® was associated with dietary quality and higher ecSI 2.0TM (r = 0.32, p = 0.008, n = 69). No associations between sDOR.2-6y™ and food security or dietary intake were noted.

Background: Prevalence of metabolic syndrome (MetS) increased from one-quarter to one-third of the U.S. adult population over 8 years and is spreading to young adults and Asian and Hispanic Americans. Diagnosed when >3 out of 5 cardiometabolic risk factors are present, there is widespread agreement that its fundamental roots are in a lifestyle characterized by poor dietary quality and physical inactivity. Past lifestyle trials for MetS produce benefits that have limited sustainability, suggesting the need for new treatment approaches. Methods: This is the design and baseline cohort of the Enhancing Lifestyles in the Metabolic Syndrome (ELM) multi-site trial. The trial tests the hypothesis that a habit-based lifestyle treatment offered over 6 months, followed by 18 monthly maintenance contacts, can produce 4 new diet, physical activity, and mindfulness habits and, if so, sustained MetS remission. The design is an individually randomized, partially clustered group treatment trial of 618 participants with the MetS recruited from 5 sites in the U.S. and randomized to a small group lifestyle treatment or an enhanced standard of care education comparator. The primary outcome is MetS remission at 24 months. Secondary outcomes compare arms at 6, 15, and 24 months on MetS components, lifestyle targets, weight, body mass index, hemoglobin A1c, LDL cholesterol, medications, quality of life, psychosocial factors, and cost-effectiveness. Results: The cohort of 618 participants was recruited by screening 14,817 over 2.5 years (screening to enrollment ratio 24:1). Recruitment exceeded the target of 600 despite 2 COVID-19 pauses. The mean age was 55.5 years, 24.3% were male, 25.5% were a racial minority, 9.7% identified as Hispanic, and 83.0% were classified as obese (body mass index >30). The most common MetS components were abdominal obesity (97.7%) and elevated blood pressure or antihypertensive medication (86.2%). Conclusions: The geographic, sociodemographic, and clinical diversity of the cohort, combined with rigorous behavioral efficacy trial methods, will provide a conclusive answer to the question of whether this habit-based lifestyle program can produce sustained 24-month remission of the MetS and thereby help to curb a significant and growing public health problem.

Eating competence (EatC) is an intra-individual approach to eating attitudes and behaviors associated with greater well-being. EatC research has not included persons with confirmed metabolic syndrome (MetS). Therefore, EatC of persons with MetS was explored to identify unique associations and inform implementation of MetS lifestyle interventions using baseline data from a multisite, randomized trial of a 2-year lifestyle intervention with MetS. EatC, measured with the Satter Eating Competence Inventory 2.0 (ecSI 2.0 (TM)), was examined for relationships with bioclinical measures (e.g., blood pressure, lipids), medication use, BMI, waist circumference, fruit/vegetable intake, and psychosocial factors, (e.g., stress, mindfulness). Data were collected in person and video call by trained research personnel. EatC was examined as a continuous score and as a categorical variable with ecSI 2.0 (TM) scores >= 32 considered eating competent. Participants (n = 618) were predominantly female (76%), White (74%), college educated (60%). Mean age was 55.5 +/- 11 y. Mean ecSI 2.0 (TM) was 29.9 +/- 7.4 and 42% were eating competent. EatC was greater for males, persons who were older and food secure. Competent eaters (vs. non-eating competent) had lower waist circumference (112.7 +/- 12.5 cm vs.116.8 +/- 16.0 cm; P < 0.001) and BMI (35.0 +/- 6.1 vs. 37.5 +/- 7.3; P < 0.001). Serum triglycerides, HDL-cholesterol, fasting blood glucose, HbA1c, and blood pressure did not differ by EatC status. Compared to non-eating competent persons, competent eaters perceived less stress, were more mindful, indicated better physical function, and more habitual vegetable intake (all P < 0.001) and sensory awareness (P < 0.05). EatC in MetS paralleled the non-MetS profile. EatC was associated with a healthier psychosocial profile, waist circumference and BMI. Findings support further research to examine the mediational or moderating influence of EatC in the treatment of MetS.