Weight loss and exercise are known interventions to improve diabetes outcomes. In this study, researchers sought to identify barriers to weight loss and physical activity and evaluate strategies employed by coaches in a real-world, community sample of adults with metabolic syndrome who took part in a Diabetes Prevention Program (DPP)-adapted weight loss intervention. These findings were then compared to those from the screened DPP sample. A telephonic DPP adaptation called SHINE (Support, Health Information, Nutrition, and Exercise) was analyzed. The intervention curriculum was delivered by primary staff, and participants received monthly weight loss direction from lifestyle coaches. Patients reported barriers to weight loss and physical activity, and coaches shared their strategies to address these barriers. The established barriers were assessed in association with demographic characteristics and then compared to DPP sample data. The most prominent weight loss barriers were problems with self-monitoring, too little physical acidity, internal thought/mood cues, vacation/holidays, and social cues. Patients participating in SHINE were much more likely to report a barrier. The main physical activity barriers were problems with self-monitoring, access/weather, time management, aches/pains, and vacation/holidays; the physical activity barriers did not correspond to DPP data. Coach-reported strategies included problem solving, self-monitoring skills review, increased physical activity, and motivational strategies. SHINE coaches had a higher likelihood of using alternative approaches compared to DPP coaches. The authors concluded that weight loss and exercise barriers were significantly more prevalent in a community sample of patients at risk for diabetes than those in a highly screened DPP sample.