Managing Obesity in Heart Failure: Latest Evidence and Knowledge Gaps

Purpose of Review This review aims to synthesize the latest evidence focused on therapies related to comorbid obesity and heart failure, with particular attention to lifestyle, pharmacological, and surgical modalities. Recent Findings Obesity is a common risk factor for heart failure, which can also exacerbate symptom burden of heart failure. Emerging treatments, such as the use of GLP-1 analogs like semaglutide, have shown promising results in improving symptoms and physical limitations in the setting of comorbid heart failure with preserved ejection fraction and obesity. Conversely, the efficacy of such treatments in heart failure with reduced ejection fraction remains uncertain, with some studies suggesting potential adverse outcomes. Lifestyle interventions, including dietary changes and structured exercise programs, may be associated with benefits in terms of functional capacity and symptom burden, and retrospective cohort studies of surgical weight loss have raised the possibility of improvements in medium term survival for patients with baseline HF, challenging the previous notions of the "obesity survival paradox”. Summary The management of comorbid obesity and heart failure is a rapidly evolving field. The interplay of pharmacological, lifestyle, and surgical interventions highlights the need for personalized treatment plans to mitigate the risks and enhance the quality of life for patients with heart failure. It is hoped that future guidelines will integrate these findings to address the nuances of optimally treating both heart failure and obesity in patients with both conditions. Graphical Abstract