Background: Chronic metabolic diseases such as obesity, hypertension, type 2 diabetes, and mood disorders frequently cluster in under-resourced communities. Increasing evidence suggests these conditions may be influenced by persistent low-grade systemic inflammation (sometimes referred to as metaflammation), as well as cumulative physiologic stress and environmental constraints. Rural Appalachian populations experience a disproportionate burden of these conditions, often compounded by poverty, food deserts, limited healthcare access, and restricted availability of preventive services.
Objective: To describe clinical and functional outcomes of a multimodal lifestyle and stress-regulation intervention implemented within routine primary care in a rural Appalachian population with multimorbidity.
Setting: A rural primary care clinic serving an under-resourced Appalachian community in the United States.
Participants: Thirty adults with multimorbidity participated in a 12-week clinic-based intervention; 22 participants completed the program and were followed through six months.
Intervention: The intervention integrated lifestyle education, hydration optimization, nutrition awareness adapted to food-desert constraints, and mindfulness-based cognitive–somatic practices designed to support stress regulation and behavioral awareness.
Primary Outcome Measures: Clinical and patient-reported outcomes, including body weight, blood pressure, depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), sleep quality, energy levels, cognitive clarity, medication burden, and available laboratory markers, including HbA1c and fasting glucose.
Results: Participants demonstrated improvements across metabolic, psychological, and functional domains. Mean PHQ-9 and GAD-7 scores decreased from approximately 18–22 at baseline to 6–9 at 12 weeks, with improvements largely sustained at six months. Weight reduction ranged from approximately 11–30 lb over the 12-week intervention period, with greater reductions observed among a subset of participants. Blood pressure and glycemic control improved, along with improvements in sleep quality, energy levels, and cognitive clarity.
Conclusions: The pragmatic lifestyle and stress-regulation intervention was associated with improvements across metabolic, psychological, and functional outcomes, indicating its potential as a complementary strategy for addressing chronic disease in underserved communities.
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