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Background Obesity is a growing global epidemic and is rapidly increasing in low- and middle-income countries like India. The rising rates of obesity and related health problems in India demand urgent, practical interventions involving healthy eating, physical activity and supportive community-based approaches.Aim and objectives This study aims to evaluate the impact of nurse-led intervention (NLI) on weight reduction among obese adults in urban Indian communities.Methods and material An exploratory sequential mixed methods design was adopted, combining qualitative focus group discussions (FGDs) and in-depth interviews (IDIs) with a quantitative randomised controlled trial (RCT). Adults aged 18–50 years were screened for obesity, recruited for the RCT and randomised into either the NLI arm, which was designed by experts using findings from the FGDs, or the general care group, which received routine care through primary health centres. Following RCT, postintervention IDIs were conducted with participants who achieved 5% or more weight loss to explore the factors that facilitated weight loss.Statistical analysis used Descriptive and inferential statistics were used.Results Screening of 982 adults revealed a high prevalence of obesity, particularly among women aged 29–50 years. The key barriers identified and addressed included lack of motivation, time and awareness, while the enablers were family support and community resources. At 12 months, 71% of participants in the NLI group achieved 5% or more weight loss, with statistically significant improvements in metabolic, dietary and physical activity outcomes. Post RCT IDIs revealed that motivation, behaviour change and social support were key drivers of sustained weight loss.Conclusion The NLI guided to meaningful weight loss and improved health indicators among obese adults in Puducherry. The findings highlight the potential of culturally adapted, nurse-led programmes and recommend broader implementation through integrated community health strategies.Trial registration number CTRI/2021/12/038785).