Along with the increasing prevalence of obesity comes a constellation of metabolic derangements: dyslipidemias, hypertension, insulin resistance, and glucose intolerance, as well as increased prothrombotic and inflammatory markers. The association of these factors has been termed the "metabolic syndrome" and increases the risk of developing cardiovascular disease. Aside from pharmaceutical therapy, lifestyle modification is necessary to aggressively treat this syndrome in its entirety. This involves a holistic approach of behavioral counseling, education, increased physical activity, and dietary modification. Even modest weight loss (7% to 10% of body weight) results in decreased fat mass, blood pressure, glucose, low-density lipoprotein, and triglyceride levels. These benefits can also translate into improved long-term outcome, especially if weight loss and lifestyle alterations are maintained. However, the remaining challenge is how to promote long-term adherence to a healthier, more active lifestyle and avoid reversion to old habits.