The aim of the study was to identify the effects of the therapeutic lifestyle modification (TLM) program on women with the metabolic syndrome in rural areas. Thirty-two women with the metabolic syndrome were randomly assigned to the intervention or control group. The women in the intervention group participated in a 4-week TLM program consisting of health screening, education, exercise, diet, and counseling. Those in the control group received a booklet with basic education for metabolic syndrome. Repeated-measures analysis of variance was used for analyzing the effects of the TLM intervention on anthropometric indicators, serologic assays, and psychosocial outcomes. The participants in the intervention group showed significant reductions in body weight (-4.6 kg vs -2.0 kg), waist circumference (-6.2 cm vs -1.7 cm), and triglyceride levels (-52.2 mg/dL vs -2.2 mg/dL) compared with those in the control group at 4 weeks (P < .01). In addition, the TLM intervention group showed significant positive behavior changes; almost all of the women tried to control their intake of food and their weight and to exercise 3 times per week. The TLM intervention showed no group and time interaction effect on systolic blood pressure, fasting glucose, high-density lipoprotein cholesterol, or low-density lipoprotein cholesterol levels. However, there was a positive time effect; after the program, high-density lipoprotein cholesterol levels increased and systolic blood pressure, fasting glucose, and low-density lipoprotein cholesterol decreased compared with levels before the intervention in both groups. These results indicate that a well-developed comprehensive TLM intervention can improve metabolic syndrome over a short-term period.