In Western Australia’s sprawling Great Southern region – underpinned by primary industry and pockets of tourism, and with a population of just 55,000 – academic, Dr Krysten Blackford, has made an impact on a condition so prevalent, it’s considered a global public health issue.
Metabolic syndrome (MetS) is a cluster of abnormalities, including high blood pressure, high blood sugar and abnormal blood lipids, which significantly increase the risk of developing cardiovascular disease and type 2 diabetes. The World Health Organization cites cardiovascular diseases as the number one cause of death, and diabetes as one of the leading causes of death, in the world.
The risk factors for MetS are obesity, unhealthy diet, reduced physical activity and sedentary behaviour. Approximately one fourth of adults worldwide are estimated to have MetS, and in Australia it has a higher prevalence in rural and remote areas.
The sobering global and national obesity statistics offer an explanation for the upward trend of MetS, with large waist size the critical factor underpinning all other parameters of the syndrome. Approximately 63% of Australia’s population is now classed as overweight or obese, an increase of around 9% in the last 17 years, and the proportion of adults aged 50+ who are overweight or obese has reached 70%. Additionally, the prevalence of obesity has been rising more among middle-aged adults living in isolated rural and remote areas of Australia. Globally, since the 1980s, obesity prevalence has increased by 28% in adults and 47% in children, equating to an estimated 2.1 billion people.
Obesity is not the only critical risk factor for MetS, however. Advancing age is a major contributor to all MetS parameters and Australia’s increasing rates of obesity, coupled with its aging population, make for a perfect storm of risk factors for a spike in chronic diseases in the coming decades.
In an attempt to reverse the impact of obesity and related health issues, public health campaigns have focused on promoting healthy eating and active lifestyles, however the rising occurrence of obesity point to their limited success. Rural and remote areas with ageing populations, limited access to health services, poor diets and physical inactivity are of particular concern to public health researchers, policy makers and health practitioners.
Ms Blackford, Collaboration for Evidence, Research and Impact in Public Health (CERIPH), School of Public Health, focused on this issue with her PhD project, ‘Development, implementation and evaluation of a diet and physical activity intervention targeting rural Australian adults with or at risk of metabolic syndrome’. She recruited at-risk 50 to 69 year olds residing in the rural community of Albany, and surrounding towns in the Great Southern region, approximately 400km from the state’s capital, Perth.
“Adults in rural areas are at an increased risk of a range of chronic diseases, which is why my research focused on this vulnerable group,” Ms Blackford said.
“Albany and surrounding towns were chosen because the number of adults aged 50 to 69 in the region is representative of other rural areas in Australia, which means the intervention strategies and program materials would be suitable for other rural areas if the program was deemed successful.”
Project participants were screened for MetS using the International Diabetes Federation criteria, and 400 eligible participants were randomly assigned to the intervention or control group. The intervention group received printed and online program materials designed to educate them about dietary and physical activity improvements, and motivational support.
“The home-based program used behaviour change approaches such as goal setting, self-monitoring and feedback, empowering participants to self-manage their health behaviours within their own environment,” Ms Blackford said.
“Motivational interviewing was a key component of the program, which was implemented by trained assistants via telephone over the six-month intervention period. Telephone support was particularly useful for reaching the rural group.”
At the end of the six-month program, the changes in participants’ behaviours and blood profiles were very encouraging. There were significant improvements in triglyceride and cholesterol, weight, waist size and body mass index. The findings suggest that home-based intervention programs, which include dietary guidance and strategies to increase physical activity, are a promising means to prevent the onset of chronic disease in rural adults.
“The health impact that can be achieved through intervention programs that motivate and empower individuals to adopt and maintain healthy behaviours is very encouraging, however this type of intervention should not be implemented in isolation,” Ms Blackford said.
“The impact of the physical and social environment on health behaviours is particularly important to consider when addressing such a complex health issue. Tackling obesity requires a comprehensive health promotion approach.”
The results from Ms Blackford’s project have led to the development of a new project, modelled on her PhD research, which has been funded by Healthway. The 18-month project, Prevention HealthPathways, will be run by CERIPH in partnership with the WA Country Health Service (WACHS) and the WA Primary Health Alliance (WAPHA).
The project, a unique model to be implemented in primary care, supports the early identification and management of adults living in rural areas, who are at high risk of developing chronic diseases. General Practitioners (GPs) will access information about MetS, and other risk factors, via a newly-developed web portal, HealthPathways, which is managed by WAPHA and provides information on referral and management pathways for a range of health issues. GPs will be able to identify and refer at risk patients to a home-based diet and physical activity program run by CERIPH.
“The WACHS acknowledges there is a current focus on the treatment of chronic disease in primary care in WA, rather than its prevention. We will be working with GPs to identify patients in need of dietary and physical activity improvements using the MetS diagnosis as a red flag. We will intervene early, rather than waiting for diabetes or heart disease to develop and then implementing management strategies,” Ms Blackford said.
“Prevention HealthPathways is part of the Action on Obesity Network, of which Curtin is a member. The network comprises organisations working within a system to address the high prevalence of obesity and associated chronic disease in the Great Southern region.
“Working with the community and forming both academic and practitioner partnerships at local, national and international levels are key to building programs and environments that support people to adopt health enhancing behaviours.”
Prevention HealthPathways will be trialed with GPs at Pioneer Health in Albany, with the potential to be rolled out to other rural areas throughout Western Australia. Results of the project will be assessed in 2018.
This article was first published in Health at Curtin as Tackling metabolic syndrome in at-risk regional WA.