The aim of this study was to examine whether additional repeated counselling further improves the health effects of limited, highly individualized lifestyle guidance in metabolic syndrome. One hundred and nine previously untreated metabolic syndrome patients received highly standardized and individualized lifestyle guidance for weight loss. A tentative goal of 5% weight reduction over the course of 2 months was set. Patients were then randomly assigned to either the multiple guidance group who received further counselling every 2 months (n = 52) or the single guidance group who received no further guidance until the final assessment 6 months later (n = 57). Baseline data between the multiple guidance and single guidance groups were similar. Body weight and waist circumference were significantly reduced, and liver function, lipid profiles and glucose metabolism were significantly improved in both groups. After adjustment for baseline data, the multiple guidance group showed considerably higher reduction in waist circumference and fasting blood sugar concentration than the single guidance group. These data suggest that additional counselling further improved the antidiabetic effects of limited individualized lifestyle guidance in metabolic syndrome.