BackgroundIn recent years, there has been a rise in the use of conversational agents for lifestyle medicine, in particular for weight-related behaviors and cardiometabolic risk factors. Little is known about the effectiveness and acceptability of and engagement with conversational and virtual agents as well as the applicability of these agents for metabolic syndrome risk factors such as an unhealthy dietary intake, physical inactivity, diabetes, and hypertension.ObjectiveThis review aimed to get a greater understanding of the virtual agents that have been developed for cardiometabolic risk factors and to review their effectiveness.MethodsA systematic review of PubMed and MEDLINE was conducted to review conversational agents for cardiometabolic risk factors, including chatbots and embodied avatars.ResultsA total of 50 studies were identified. Overall, chatbots and avatars appear to have the potential to improve weight-related behaviors such as dietary intake and physical activity. There were limited studies on hypertension and diabetes. Patients seemed interested in using chatbots and avatars for modifying cardiometabolic risk factors, and adherence was acceptable across the studies, except for studies of virtual agents for diabetes. However, there is a need for randomized controlled trials to confirm this finding. As there were only a few clinical trials, more research is needed to confirm whether conversational coaches may assist with cardiovascular disease and diabetes, and physical activity.ConclusionsConversational coaches may regulate cardiometabolic risk factors; however, quality trials are needed to expand the evidence base. A future chatbot could be tailored to metabolic syndrome specifically, targeting all the areas covered in the literature, which would be novel.