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Abstract Background The present case study investigated the feasibility of using manga (Japanese-style comic books) to promote physical activity and healthy eating behavior in Japanese patients with metabolic syndrome. Methods A one-arm pre-post intervention was conducted in a Japanese suburban community. Twenty participants with a diagnosis of metabolic syndrome were recruited via health checkups. Health promotion manga were developed by the researcher, a publishing specialist, and a professional illustrator. We measured participants’ self-reported physical activity, eating behavior, and psychological readiness to change toward engaging in healthy behavior. Results At 1 month after the intervention there were no significant differences in physical activity scores, but small positive changes in vigorous (R 2  = 0.02) and moderate (R 2  = 0.01) physical activity scores were observed. Total healthy eating behavior scores were significantly improved (p < 0.05, R 2  = 0.47). In addition, participants reported positive change in psychological readiness, such as increased intention to engage in healthy behavior, enhanced self-efficacy, and benefits of using manga. Conclusions This study demonstrates that manga interventions have potential to encourage healthy eating in patients with metabolic syndrome.