Impact of Dietetic Counseling Combined With Digital Tools on Obesity‐Related Indices in Greek Adults: The GATEKEEPER Study

OBJECTIVE: This study aimed to evaluate the effectiveness of dietetic counseling with digital tools on obesity-related and metabolic outcomes in adults aged ≥ 55 years at high risk for metabolic syndrome (MetS). METHODS: In this 3-month randomized controlled trial, 984 adults aged ≥ 55 years with ≥ 1 MetS risk factor were randomized (1:1:1) to: standard care (monthly dietetic counseling), standard care plus web-based platform, or standard care plus platform and digital devices. Analyses included 954 participants and used linear mixed-effect models under a missing-at-random assumption adjusted for age and sex. The primary outcome was change in waist circumference. Secondary outcomes included BMI, body composition indices, physical activity, and glycemic markers. RESULTS: Waist circumference decreased in all groups (-6.29, -4.92, -4.69 cm), with smaller reductions in the platform (MD -1.38 cm; 95% CI -2.37 to -0.38) and platform + devices groups (MD -1.61 cm; 95% CI -2.61 to -0.60). BMI, body composition indices, and glycemic markers improved similarly across groups. Physical activity increased more in the platform + devices group (MD +55.52 MET-min/week; 95% CI 15.32 to 95.72). CONCLUSIONS: Dietetic counseling improved anthropometric and metabolic outcomes in adults at risk for MetS. Digital tools enhanced physical activity but did not provide additional short-term metabolic benefits. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05031299.