Lifestyle interventions can effectively reduce chronic disease risk factors. This study examined the effectiveness of an established lifestyle intervention contextualized for low-literacy communities in Fiji. Ninety-six adults from four villages, with waist circumference (WC) indicative of risk of chronic disease, were randomly selected to an intervention or control group. Process evaluation indicated one intervention and one control village fulfilled the study protocol. There were no differences between intervention and control for body mass index BMI (P = 0.696), WC (P = 0.662), total cholesterol (TC) (P = 0.386), and TC:high-density lipoprotein (HDL) ratio (P = 0.485). The intervention village achieved greater reductions than the control village at 30 and 90 days for systolic blood pressure (30 days: −11.1% vs. −2.5%, P = 0.006; 90 days: −14.5% vs. −6.7%, P = 0.019); pulse rate (30 days: −7.0% vs. −1.1%, P = 0.866; 90 days: −7.1% vs. 4.3%, P = 0.027), and HDL (30 days: −13.9% vs. 1.7%, P = 0.206; 90 days: −18.9% vs. 2.2%, P = 0.001); at 90 days only for diastolic blood pressure (−14.4% vs. −0.2%, P = 0.010); at 30 days only for low-density lipoprotein (−11.6% vs. 8.0%, P = 0.009); and fasting plasma glucose (−10.2% vs. 4.3%, P = 0.032). However, for triglycerides, the control achieved greater reductions than the intervention village at 30 days (35.4% vs. −12.3%, P = 0.008; marginal at 90 days 16.4% vs. −23.5%, P = 0.054). This study provides preliminary evidence of the feasibility and potential effectiveness of the intervention to lower several risk factors for chronic disease over 30 days in rural settings in Fiji and supports consideration of larger studies.