OBJECTIVE: To systematically review weight and cardiovascular risk reduction in blacks by diet and lifestyle changes. DESIGN: Randomised and non-randomised controlled trials of diet with/without lifestyle changes with duration of intervention ≥3 months, and published between January 1990 and December 2009, were searched in electronic databases including MEDLINE, EMBASE, CINAHL and CCTR (Cochrane Controlled Trials Register). Studies were included if they reported weight/BMI changes with changes in at least one of the following: systolic and diastolic blood pressure, fasting plasma lipids and glucose, and glycated haemoglobin. SETTING: Clinical, community and church-based interventions. SUBJECTS: Study participants were of African ancestry (blacks). RESULTS: Eighteen studies met the inclusion criteria. Average mean difference in weight loss was -2·66 kg, with improvements in all outcomes except total cholesterol. No significant difference was observed in outcome measures between all studies and studies that recruited only healthy participants or patients with type 2 diabetes. CONCLUSIONS: Diet and lifestyle changes result in weight loss with improvements in cardiovascular risk factors in blacks. However, more culturally tailored programmes have been suggested to motivate and encourage blacks to participate in intervention trials.