Managing Obesity in Individuals with Cardiovascular Disease: Are We Missing the Obvious?

Obesity is a modifiable driver of cardiovascular disease and coexistent diabetes adds to adverse vascular outcomes. Guidelines uniformly highlight weight management as a cornerstone of cardiovascular prevention and recommend stepwise strategies starting with lifestyle modifications, then pharmacotherapies, followed by bariatric surgery in non-responders. Despite a large body of evidence, use of weight loss cardiovascular protective agents remains low in clinical practice due to high costs and limited familiarity. Additional barriers include inadequate prioritisation of weight management in cardiac care, fragmented cross-specialties coordination, and lack of specific guidance in some high-risk groups (e.g. those with type 1 diabetes). Given various difficulties, implementation of effective anti-obesity strategies remains suboptimal and requires more support of non-specialists together with greater efforts to align healthcare provider practices and system-level policies to ensure the delivery of equitable and sustainable weight loss interventions at scale.