Obesity and Cardiovascular Disease: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2026

Obesity is a chronic disease that directly contributes to cardiovascular disease (CVD) through biomechanical "fat mass disease" and dysfunction of epicardial adipose tissue, or "sick fat disease." It also indirectly promotes CVD through adiposopathic immune and endocrine abnormalities that drive type 2 diabetes mellitus, hypertension, dyslipidemia, and thrombosis - all major CVD risk factors. This Clinical Practice Statement (CPS) reviews obesity-related cardiovascular disease pathology and outlines evidence-based strategies for clinical management.

This CPS is based on a review of relevant medical literature, interpreted through the clinical expertise of authors specializing in obesity medicine, all members of the Obesity Medicine Association (OMA). Organized into 26 sections, each includes an introduction, essential principles, a "top ten" list of key points, and a summary figure.

The CPS reviews how obesity intersects with major cardiovascular risk factors, including type 2 diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, and thrombosis. Additional metabolic complications such as metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic kidney disease further elevate CVD risk. The CPS details obesity's impact on cardiac structure and function, including its role in heart failure with preserved ejection fraction (HFpEF), atrial fibrillation, and CVD considerations in patients with obstructive sleep apnea, cancer, and psychiatric disease. It also addresses the "obesity paradox," social determinants of health, pediatric considerations, and disparities by age, sex, and race. Also included are CVD diagnostic challenges and comprehensive management strategies, including medical nutrition therapy, physical activity, behavioral intervention, cardiometabolic medications, glucagon-like peptide-1 receptor agonists, and bariatric procedures.

Effective reduction of obesity-related CVD risk requires shifting from treating downstream risk factors to addressing excessive adipose tissue itself, along with improving adipose tissue function. Clinically, this approach is often manifest by a "treat obesity first" approach. Precision diagnostics, lifestyle therapy, obesity medications, and bariatric procedures can modify both adiposopathy ("sick fat disease") and fat mass disease, improving long-term cardiovascular outcomes.