Time-restricted eating (TRE) limits daily dietary intake to a recurring 4-10 hour eating window and may improve cardiometabolic health. However, the effects of TRE are difficult to interpret as in clinical practice, it is often combined with exercise, calorie restriction or other lifestyle interventions, confounding their effects. (1,2) This systematic review aimed to evaluate the effect of TRE interventions on body mass index (BMI), body weight, waist circumference (WC) and central adiposity in adults with cardiovascular disease or elevated cardiometabolic risk. Systematic research was conducted using MEDLINE, Embase, CINAHL, Scopus and CENTRAL from inception to 29th July 2026. Of 10507 records screened, 38 studies met inclusion criteria. Outcomes were coded as decrease, neutral or increase when reported between-group tests or clearly non-overlapping confidence intervals showed that a TRE-containing intervention differed from comparator; otherwise, reported outcomes were coded neutral. Risk of bias for the included trials was independently assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Among the 38 studies, 24 used an 8-hour eating window (16:8), 3 used a 6-hour window (18:6), 6 used a 9–10-hour window, and 5 used multiple or other eating-window patterns for TRE. BMI and body weight were reported in 32 papers; 22 showed a decrease following TRE alone or TRE combined with co-interventions (e.g., physical activity, calorie restriction, dietary counselling, or a Mediterranean diet), with BMI reduction ranged from 0.5 to 4.7 kg/m² or equivalent body weight. WC was reported in 19 papers; 14 showed a decrease with reductions ranging from 1.9 to 8.0 cm, and 5 were neutral and none showed an increase. Central adiposity was reported in 10 papers; 5 showed a decrease (reduction ranging from 1.6 to 2.9 kg, or 0.9% to 9.4%), and 5 was neutral and none showed an increase. In studies, including those with multiple comparative arms, body composition improvements were more frequently observed when the TRE intervention (whether administered alone or combined with other modifications) was compared against a non-active control (e.g., usual care or ad libitum diet) rather than an active lifestyle comparator (e.g., continuous calorie restriction). Across all included studies, TRE interventions (alone or combined) most consistently reduced BMI/body weight and WC, while evidence for central adiposity was smaller and mixed. Overall, the included studies demonstrated a low to moderate risk of bias. TRE is an effective dietary strategy for reducing body weight, BMI, and waist circumference in adults with or at high risk for cardiovascular disease, particularly when compared to ad libitum diets. In summary, while TRE consistently improves general anthropometric markers, its specific effects on central adiposity remain inconclusive. Future high-quality, rigorously controlled trials are needed to isolate the independent effects of TRE from concurrent lifestyle modifications.