In a major development, a new study in India called PROLIFIC, which found strong evidence that changing a person's lifestyle with the help of their family can make it much easier to control their weight and lower the health risks that come with being overweight in people who have a family history of early coronary heart disease (CHD). The study's findings underscore the potential of community-based solutions for reducing India's growing noncommunicable disease (NCD) burden.

The PROLIFIC study used a cluster randomised controlled trial (RCT) design, with 1,671 individuals (including 1,111 women) from 750 households divided into two groups: the intervention group and the usual care group. Nonphysician health workers (NPHWs) provided organised counselling to the intervention group, including regular home visits, goal-setting sessions, and peer group discussions about food, physical activity, and cardiovascular health. In comparison, the usual care group receives one-time counselling and annual cardiovascular risk testing with no ongoing follow-up. 

After two years of follow-up, the intervention group showed significant improvement in key obesity indicators compared to the usual care group. Participants in the intervention arm lost an average of 2.61 kg, decreased their BMI by 1.06 kg/m², and reduced their waist circumference by 4.17 cm, all with statistical significance (P <.001). These decreases are especially significant given that deliberate weight loss is associated with a 25% to 32% decreased incidence of type 2 diabetes in high-risk individuals. 

Structured lifestyle modification strategies, such as those used in the PROLIFIC research, have been shown to be more effective than pharmaceutical approaches at delaying diabetes development and improving cardiovascular risk factors. This conclusion is supported by findings from a 2017 meta-analysis published in The Lancet Diabetes & Endocrinology, which found that postponing diabetes onset by 10 years can result in a 3–4- year improvement in life expectancy. These findings emphasise the need for preventive measures that prioritise long-term lifestyle improvements over short-term pharmacological therapies. 

In essence, the observed weight, BMI, and waist circumference reductions are not isolated measurements; rather, they point to broader health advantages. The study's findings indicate that well-structured lifestyle treatments can dramatically reduce risk factors for chronic diseases, providing a potential road to improved cardiovascular and metabolic health in high-risk groups. 

The intervention's success was largely dependent on the high level of participant engagement. Over a two-year period, NPHWs conducted an average of 13 visits per household, and 86% of participants evaluated their health goals at least three times. The high adherence rate aided the intervention's success, emphasising the need for persistent follow-up and reinforcement of health objectives. 

Family-based therapy uses strong familial relationships and a shared environment to promote behavioural change. Unlike individual-level therapies, family-based approaches promote collaborative decision-making and accountability, making it easier for people to maintain healthy lives. According to studies, family members play an important role in establishing food habits, physical activity patterns, and health-related behaviours, which explains why the PROLIFIC trial yielded better results than individual-level SLM programs. 

The PROLIFIC study proposes a scalable strat programme that might be implemented in India's Ayushman Bharat Health and Wellness Centres (AB-HWCs), which now total over 150,000. Given the effectiveness of NPHW-led programs in improving mother and child health outcomes, broadening their role to encompass family-based cardiovascular risk management has enormous promise. Scaling up these therapies using the current AB-HWC infrastructure could significantly improve population-level efforts to prevent and manage chronic illnesses. 

The PROLIFIC study's success highlights the necessity of community-centred, family-based therapies in addressing India's central NCD burden. As India's obesity, diabetes, and cardiovascular disease rates rise, it is critical that evidence-based interventions are integrated into national health programs. Encouraging family-based lifestyle changes through NPHWs and AB-HWCs could significantly contribute to the creation of a sustainable, preventive health ecosystem, empowering communities and reducing long-term healthcare expenses.