ORCID

0000-0002-8163-0527 (Carbone)

Document Type

Article

Publication Date

2026

DOI

10.1007/s11886-025-02333-5

Publication Title

Current Cardiology Reports

Volume

28

Issue

1

Pages

4

Abstract

Purpose of review

While excess adiposity is a known risk factor for incident heart failure ( HF), once the condition is established, observational data suggest that increased body mass index (BMI) may confer a survival advantage. This paradox has emphasized the underlying roles of cardiorespiratory fitness (CRF), and body composition, particularly lean mass (LM), in influencing clinical outcomes.

Recent findings

In this review, we explore the multifaceted nature of the obesity paradox in HF, with a focus on emerging anti-obesity incretin-mimetic therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. These agents have demonstrated remarkable efficacy in weight reduction and favorable cardiovascular profiles in patients with HF with preserved ejection fraction (EF), yet their use in other HF populations, such as HF with reduced EF, raises important clinical questions and the urgent need for future research. Concerns include the potential for LM loss, implications for sarcopenic obesity, and the uncertain impact of weight loss on outcomes in patients who may not benefit from weight loss. We also highlight the need to assess therapeutic outcomes beyond BMI, incorporating measures of CRF, such as peak oxygen consumption (VO₂ peak), quality of life, and functional capacity, using tools such as the 6-minute walk test. Barriers to implementation, including cost, provider hesitation, insurance restrictions, and patient level challenges are also reviewed.

Summary

Finally, we call for future research using contemporary cohorts and advanced phenotyping to reevaluate the obesity paradox in the context of modern pharmacologic interventions. As obesity treatment continues to evolve, a patient-centered, individualized approach that integrates body composition, functional status, and comorbid conditions will be essential in optimizing care for individuals with HF.

Rights

© 2026 The Authors.

This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original authors and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Data Availability

Article states: "No datasets were generated or analysed during the current study."

Original Publication Citation

Alebna, P. L., Martey, S., Mehta, A., Lavie, C. J., & Carbone, S. (2026). The treatment of obesity in the context of the obesity paradox in patients with heart failure: A narrative review. Current Cardiology Reports, 28(1), Article 4. https://doi.org/10.1007/s11886-025-02333-5

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