The Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) project was a one-year feasibility study of lifestyle treatment (i.e. diet and exercise) of metabolic syndrome. This secondary analysis examined dietitian counselling and participants’ food behaviour changes over 12 months. The results indicated that, similar to the 3-month results, dietitians mainly focused on a group of food behaviour goals (e.g. Balanced meals, Increase fruit and vegetables, etc.) and behaviour change techniques (e.g. Review of goals, Goal setting, Feedback on performance, etc.) while others were seldom used. Participants changed and maintained some food behaviours over one year, with the greatest changes in participants with poorer baseline diet. Some food behaviours were more easily changed than others. Qualitatively, some, but not all food behaviour changes seemed to be associated with food behaviour goals dietitians used in counselling. More research is needed to understand patient dietary behaviour change and dietitian counselling.