Lifestyle interventions can treat metabolic syndrome and prevent type 2 diabetes mellitus, but they remain underutilised in routine practice. In 2010, an LI model was created in a rural primary care practice and spread with few resources to four other rural practices. A retrospective chart review evaluated changes in health indicators in two practice environments by following 372 participants, mainly women (mean age 52 years). Participants had a mean body mass index of 37 kg/m2at baseline and lost an average of 12% of their initial body weight as a result of the intervention. Among participants at the first intervention site for whom cardiometabolic data were available, the prevalence of metabolic syndrome decreased from 58% at baseline to 19% at follow-up. Taken as a whole, our experience suggests that LIs are feasible and deliver meaningful results in routine primary care practice.