Unhealthy lifestyle behaviors such as poor diets and physical inactivity account for most of the cardiometabolic disease (CMD) burden, including type 2 diabetes and cardiovascular diseases. Much of this burden is mediated by the effects of unhealthy lifestyle behaviors on overweight and obesity, and disproportionally impacts certain population groups—including those from disadvantaged socioeconomic backgrounds. Combined lifestyle interventions (CLIs), which target multiple behaviors, have the potential to prevent CMD, but their implementation, reach and effectiveness in routine practice are often limited. Considering the increasing availability of effective but expensive pharmaceutical options for weight loss, we review the short-term and long-term benefits and cost-effectiveness of CLIs on overweight, obesity and associated CMDs, in controlled studies and in routine care. Against the backdrop of changing living environments, we discuss the effective components of CLIs and the many challenges associated with implementing them. Finally, we outline future directions for research and implications for policy and practice to improve lifestyle behaviors and cardiometabolic health at the population level.

不良饮食和缺乏身体活动等不健康的生活方式行为占心脏代谢疾病 （CMD） 负担的大部分，包括 2 型糖尿病和心血管疾病。这种负担在很大程度上是由不健康的生活方式行为对超重和肥胖的影响介导的，并且不成比例地影响某些人群——包括那些来自弱势社会经济背景的人。针对多种行为的联合生活方式干预 （CLIs） 有可能预防 CMD，但它们在常规实践中的实施、覆盖面和有效性往往是有限的。考虑到有效但昂贵的减肥药物选择越来越可用，我们在对照研究和常规护理中回顾了 CLIs 对超重、肥胖和相关 CMD 的短期和长期益处和成本效益。在不断变化的生活环境背景下，我们讨论了 CLI 的有效组成部分以及与实施它们相关的许多挑战。最后，我们概述了未来的研究方向以及对改善人口水平生活方式行为和心脏代谢健康的政策和实践的影响。