Objectives: The objective of the study was to examine the clustering patterns and correlates of multiple health behaviors (MHBs) in middle-aged Koreans with metabolic syndrome (MetS). Methods: Data on sociodemographics, clinical characteristics, health behaviors (vegetable intake, physical activity, cigarette smoking, and alcohol consumption), and psychological characteristics were collected by a self-reported survey and medical examination from 331 individuals with MetS. Clustering of MHBs was examined by measuring 1) the ratios of observed and expected prevalence of MHBs, and 2) the prevalence odds ratios. A binomial logistic regression were conducted. Results: Men were more likely than women to engage in multiple unhealthy behaviors. Clustering of smoking and heavy drinking was exhibited in the participants. Women with high vegetable intake were more likely to be physically inactive, and those with inadequate vegetable intake were more likely to be physically active. Those with lower self-regulation were more likely to engage in unhealthy behaviors. Conclusions: The findings support the multiple health behavior approach as opposed to the individual health behavior approach. Emphasis of self-regulation is necessary in developing multiple behavior intervention for individuals with MetS.