Targeting Metabolic Syndrome with a Pre-Conception True-Couples-Based Lifestyle Intervention: A Pre-Post Mixed-Methods Evaluation

Background/Objectives: Metabolic syndrome (Mets) risk is influenced by both parents’ preconception lifestyle, yet most interventions target individuals rather than couples. True couples-based interventions that engage both partners equally remain rare. This study aimed to assess the feasibility and adherence of a 10-week lifestyle intervention delivered to heterosexual couples in the preconception period. Methods: This was a pre-post mixed-methods study involving eight nulliparous, cohabiting couples (N = 16 participants) planning a pregnancy within three years. Couples received tailored dietary and physical activity advice via remote sessions. Qualitative data were collected through post-intervention dyadic interviews and thematically analysed to explore participants’ experiences and perspectives on feasibility and adherence. Quantitative data on anthropometry, dietary intake (serves from five food groups), and sedentary behaviour were descriptively analysed. Wilcoxon signed-rank tests were used to assess changes in paired outcomes. Results: qualitative findings highlighted shared motivation, mutual accountability, cultural barriers, and the practicality of the intervention structure. All couples completed the intervention (100% retention). Among participants who required change, improvements were observed in all eight individuals for body mass index and in five out of seven individuals for waist-to-hip ratio. Statistically significant improvements were found in BMI (p = 0.027) and grain intake (p = 0.002), while other dietary and anthropometric changes were not significant. Dietary improvements were noted in 43 out of 80 observations across vegetables, fruits, grains, protein, and dairy intake. Sedentary hours were reduced in 12 of 16 participants, though increases in physical activity intensity were limited. Conclusions: A true-couples-based lifestyle intervention is feasible and acceptable in the preconception period. The approach shows potential for improving diet and reducing sedentary behaviour. Future research with a larger sample and longer duration is recommended to assess long-term effectiveness and broader applicability.