Objective: Rural areas may suffer from a lack of access to health care and programmes to promote behaviours such as healthy eating and physical activity. Point-of-testing counselling is a method of promoting a healthy lifestyle during an individual's most "teachable moment". Design/Setting: This longitudinal study examined the effects of school-based nutrition education and point-of-testing counselling on nutrition knowledge, weight, blood lipid profile and blood pressure over a 3-year period (2005-2008) among junior high and high school students from a rural community in the Southern USA. Methods: Screening for health variables, followed by point-of-testing counselling sessions, was offered every 6?months, along with nutrition education once a week for 12?weeks. Statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS). T-tests and analysis of variance (ANOVA) were conducted to analyse changes in health outcomes over the course of the study. Results: A total of 233 rural students participated in this longitudinal community-based study. Students who attended at least four sessions (n?=?52) were analysed for changes in health outcomes. High-density lipoprotein levels significantly increased between the second and fourth visits. Attending the intervention at least four times stabilised or improved blood values and anthropometric measurements. Significant nutrition knowledge increases were documented among 7th and 8th graders; 6th, 9th and 10th graders also showed modest improvements. Conclusion: Using point-of-testing counselling may be an effective strategy in delaying or preventing the onset of risk factors for obesity and related chronic diseases during adolescence.