Targeting Obesity for Heart Failure

Obesity is a growing global health challenge and a significant contributor to the rising prevalence of heart failure (HF), affecting both HF with preserved and reduced ejection fraction. While obesity increases HF incidence through haemodynamic stress, neurohormonal activation, metabolic dysfunction and systemic inflammation, the so-called 'obesity paradox' complicates our understanding of prognosis in established HF. This review examines the complex bidirectional relationship between obesity and HF, summarising evidence for the effects of intentional weight loss on cardiac structure, function and clinical outcomes. Bariatric surgery provides consistent benefits across HF phenotypes, while dietary and pharmacological interventions, particularly glucagon-like peptide-1 (GLP-1) receptor agonists, show promise for cardiometabolic improvement. Emerging evidence also supports structured exercise and rehabilitation programmes. However, gaps remain regarding the long-term efficacy of interventions and the additive benefit of GLP-1 receptor agonists with sodium-glucose cotransporter-2 inhibitors. Understanding and targeting obesity in HF is essential for the improvement in morbidity and mortality in this high-risk population.