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Multidisciplinary Approach to Obesity Management: A Case Report
Published on: May 30, 2025
Complex interaction of obesity, intentional weight loss and heart failure: a systematic review and meta-analysis
Rajiv Mahajan1,2, Michael Stokes1,3, Adrian Elliott1,3
1Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia.
Insights
Obesity increases heart failure risk, but paradoxically lowers all-cause mortality. Bariatric surgery-induced weight loss improves cardiac structure and function in obese individuals.
Area of Science:
- Cardiology
- Metabolic Disorders
- Bariatric Surgery Outcomes
Background:
- Obesity is a significant risk factor for heart failure (HF).
- The relationship between body mass index (BMI) and cardiovascular outcomes, including HF, is complex.
- The impact of weight loss on cardiac function in obese individuals requires further elucidation.
Purpose of the Study:
- To determine the association between obesity and heart failure (HF).
- To investigate the cardiac impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obese subjects.
Main Methods:
- A meta-analysis was conducted using data from MEDLINE, Embase, and Web of Science up to April 2018.
- Studies examining the association and prognostic impact of obesity in HF were included.
- Studies assessing the effects of bariatric surgery-induced weight loss on cardiac parameters in obese individuals were analyzed.
Main Results:
- A 'J curve' relationship was observed between BMI and HF risk, with the highest risk in morbidly obese individuals.
- An 'obesity paradox' was noted for all-cause mortality, but the overweight group showed lower cardiovascular mortality.
- Intentional weight loss post-bariatric surgery led to reduced left ventricular mass index, improved diastolic function, and decreased left atrial size in obese patients.
Conclusions:
- Obesity elevates HF risk, yet is linked to an 'obesity paradox' in all-cause mortality, with overweight individuals having the lowest cardiovascular mortality.
- Intentional weight loss through bariatric surgery significantly improves cardiac structure and myocardial function in obese patients.
Objective:
The aim of the meta-analysis was to determine the association of obesity and heart failure (HF) and the cardiac impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obese subjects.
Methods:
MEDLINE, Embase and Web of Science were searched up to 3 April 2018. Studies reporting association and prognostic impact of obesity in HF and the impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obesity were included in the meta-analysis.
Results:
4959 citations were reviewed. After exclusions, 29 studies were analysed. A 'J curve' relationship was observed between body mass index (BMI) and risk of HF with maximum risk in the morbidly obese (1.73 (95% CI 1.30 to 2.31), p<0.001, n=11). Although 'obesity paradox' was observed for all-cause mortality, the overweight group was associated with lower cardiovascular (CV) mortality (OR=0.86 (95% CI 0.79 to 0.94), n=11) with no significant differences across other BMI groups. Intentional weight loss induced by bariatric surgery in obese patients (n=9) without established HF, atrial fibrillation or known coronary artery disease, was associated with a reduction in left ventricular mass index (p<0.0001), improvement in left ventricular diastolic function (p≤0.0001) and a reduction in left atrial size (p=0.02).
Conclusions:
Despite the increased risk of HF with obesity, an 'obesity paradox' is observed for all-cause mortality. However, the nadir for CV mortality is observed in the overweight group. Importantly, intentional weight loss was associated with improvement in indices of cardiac structure and myocardial function in obese patients.
Trial Registration Number:
APP 74412.
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