Participants in this group attended face-to-face consultations at baseline, and at the 1st, 2nd, and 3rd months (a total of four visits). These sessions focused on providing guidance for dietary and lifestyle modifications.

This group followed the same face-to-face consultation schedule as the intervention group (baseline, 1st, 2nd, and 3rd months). In addition, participants were contacted weekly via phone to assess dietary adherence and provide ongoing motivation and support, making this a more frequent and intensive intervention.

Across all groups, the study primarily aimed to evaluate changes in weight loss, blood sugar, lipid levels, and metabolic syndrome parameters, while assessing the impact of intervention intensity on these outcomes.

Participants in this group were seen in person only twice, at baseline and at the 3rd month. No additional interventions were applied, and the aim was to observe the natural course of their condition.

This intervention uniquely focuses on the frequency of dietitian-led follow-up visits and their impact on metabolic syndrome-related parameters. The study includes three distinct groups with varying levels of follow-up intensity (control, intervention, and intensive intervention).

Waist circumference, which is an indicator of abdominal obesity, the central component of metabolic syndrome, was determined as the primary outcome because of its strong association with cardiometabolic risk and its correlation with other MetS components, and because it is a significant measure in reflecting the overall effect of the intervention.

The change in the number of individuals with the following metabolic syndrome criteria has been determined as a secondary outcome:

• Elevated fasting plasma glucose (number of individuals with ≥100 mg/dL),
• Elevated triglycerides (number of individuals with ≥150 mg/dL),
• Low HDL-C (number of individuals with <50 mg/dL in women and <40 mg/dL in men),
• Elevated blood pressure (number of individuals with systolic ≥130 mmHg and/or diastolic ≥85 mmHg).

Multiple assessments with different units of measurement will be combined into a single reported value based on the change in the number of individuals meeting these conditions.