2025 ACC Scientific Statement on the Management of Obesity in Adults With Heart Failure: A Report of the American College of Cardiology.

Obesity confers increased risks of HF, coronary artery disease, and stroke, and weight loss can reduce cardiovascular disease risk. Given emerging evidence of the benefits of semaglutide and tirzepatide in individuals with HFpEF and obesity in concert with healthy behavioral interventions, clinicians should be aware of optimal diagnosis, risk assessment, and management of obesity in individuals with HF. Despite the early promise of anti-obesity medications in HFpEF, challenges remain, including whether BMI is the optimal metric to identify obesity and subsequent benefit from anti-obesity medications; the safety profile of anti-obesity medications for individuals with HF, particularly HFrEF; and whether the benefits of anti-obesity medications are attributed mainly to the magnitude of weight loss or due to other mechanisms of action. Motivated by this emerging evidence and ongoing challenges, this scientific statement: 1) reviews the diagnosis, evaluation, and risk assessment of obesity in HF; 2) describes HF-specific management strategies from lifestyle intervention to medications to surgery; and 3) addresses evidence gaps and future directions in obesity-related HF. With accurate evaluation of obesity as well as administration and monitoring of safe and effective interventions, clinicians may improve quality of life and functional capacity and potentially reduce HF events in individuals living with HF and obesity.