A comprehensive approach to obesity in heart failure patients

Obesity and heart failure (HF) often go hand in hand, and addressing this connection is crucial for improving patient outcomes. Here is a breakdown of the diagnosis, evaluation, and management of obesity in individuals with heart failure:

Diagnosis: While Body Mass Index (BMI) is a common measure for obesity, it is not always the best indicator, especially for those with a BMI under 35. In such cases, other methods like waist circumference or body composition can provide a clearer picture of a person's weight-related health risks.

Risk assessment and evaluation: People with obesity may have lower levels of natriuretic peptides, which are commonly used to diagnose heart failure. This can make it harder to diagnose HF in those with obesity, especially if symptoms like shortness of breath or fatigue are present. Additionally, conditions like diabetes, high blood pressure, sleep apnoea, and atrial fibrillation are often linked to obesity, and addressing these can help improve heart failure treatment.

Management

• Lifestyle changes: Weight loss and exercise can improve heart function, but making these changes is not always easy or sustainable.

• Medications: For people with heart failure and obesity, medications like GLP-1 antagonists (semaglutide and tirzepatide) have shown promise in reducing weight and improving symptoms. However, careful monitoring of kidney function and other treatments is essential.

• Surgery: Bariatric surgery may help reduce heart failure symptoms, but it carries risks, so it's vital to manage heart failure carefully before and after the procedure.

Overall, managing obesity in heart failure patients requires a balanced approach, combining lifestyle, medication, and sometimes surgery, under careful medical supervision.

Source: Journal of the American College of Cardiology