Impact of increasing overweight and obesity on breathlessness: a review

To summarize and critically interpret new evidence (from the last 12-18 months) on the associations between obesity and breathlessness, including epidemiology, physiological mechanisms, diagnostic challenges, and treatment approaches.

Multiple large cohorts confirm that obesity is one of the strongest independent predictors of exertional breathlessness. Recent work has expanded the understanding of mechanical, metabolic, and ventilatory contributors to breathlessness in obesity. Novel spirometric and oscillometric data clarify small airway dysfunction and decreased lung compliance. Obesity-related cardiac loading could be an important and potentially treatable contributor to breathlessness. Interventional studies show improvements in breathlessness following weight loss, particularly after bariatric procedures, though data on pharmacologic weight-loss therapies remain limited.

Obesity is strongly associated with breathlessness and likely contributes through combined mechanical, metabolic, and ventilatory factors. Treatment remains centred on weight loss, but the evidence is scarce. Future work should prioritize breathlessness-specific outcomes in obesity interventions.