This study explores African American adults' understanding of metabolic syndrome (MetS) and their motivations for making lifestyle changes. African Americans have a greater risk for components of MetS, such as hypertension. Three focus groups were conducted with African American adults (n = 11) with MetS. Content analysis revealed five themes: Threat of Poor Health, Building Trust With Providers, Gaining Social Support, Seeking Culturally Acceptable Alternatives, and Getting on Track and Staying on Track. Lifestyle interventions for African Americans with MetS need to focus on building trust, developing self-monitoring skills, social support, and identifying low-cost/convenient opportunities for physical activity.http://dx.doi.org/10.1177/1043659609357636