Obesity and the heart: a connection that calls for a comprehensive approach

For decades, obesity was viewed primarily as a matter of weight, appearance or willpower. Today, scientific evidence shows a more complex reality: it is a chronic disease that can directly affect cardiovascular health.

The scale of the problem is concerning. In 2022, more than one billion people worldwide were living with obesity, nearly 13% of the global population. Projections indicate that by 2035, around 1.9 billion adults—approximately 25% of the world’s population—could be affected.

The connection with the heart is particularly significant: an estimated two-thirds of the excess mortality associated with obesity is attributable to cardiovascular disease. Specialists therefore caution that conditions such as hypertension, high cholesterol, type 2 diabetes and heart failure should not always be considered in isolation, but as part of a broader discussion of cardiometabolic health.

How obesity affects the cardiovascular system

Obesity can damage the heart and blood vessels through several interconnected pathways. Excess body fat, particularly visceral fat, can release inflammatory and hormonal substances that contribute to higher blood pressure, alter the body’s response to insulin and increase cardiometabolic risk.

Cardiologist Pedro Caravaca, a specialist in the Heart Failure and Transplant Unit at Hospital Clínic de Barcelona, explains that these mechanisms can directly affect the cardiovascular system. As body fat increases, particularly fat stored around the organs, it can also increase the release of signals that disrupt the balance of blood pressure, metabolism and inflammation.

Fat can also accumulate in less visible areas, including around the heart and arteries. There, it can contribute to inflammation, vascular stiffness and the formation of plaques that obstruct blood flow. Over time, this added burden may contribute to hypertension, coronary artery disease, arrhythmias or heart failure.

In some patients, the heart may become stiffer and have to work harder. Although it may initially appear to function normally, this sustained strain can lead to symptoms such as fatigue, shortness of breath and reduced capacity for physical activity.

From isolated risk factors to a cardiometabolic perspective

Cardiovascular medicine is changing the way it approaches obesity. For years, treatment focused on controlling factors such as blood pressure, cholesterol and blood glucose separately. Today, scientific consensus emphasizes that these problems may share an underlying metabolic cause and that cardiovascular assessment in people with obesity should be broader: body fat distribution, blood pressure, blood lipids and glucose, sleep, physical activity, mental health, functional capacity and coexisting conditions.

Recent research has also explored more deeply how obesity can affect the heart’s structure and function, including the role of fat surrounding the organ, local inflammation and cardiac stiffness. These findings reinforce a central idea: obesity management should be assessed not only through weight loss, but also through its potential effects on cardiometabolic health, always taking into account the available evidence, each patient’s clinical profile and the approved indication for each treatment.

A chronic disease requiring comprehensive treatment

Current consensus statements, led by the European Society of Cardiology, propose a shift in perspective: obesity should no longer be viewed only as a risk factor, but as a chronic systemic disease and an important treatment target for improving cardiovascular health and life expectancy.

Treatment must be comprehensive, individualized and sustained. Lifestyle interventions remain essential and include nutrition, physical activity, good sleep management and psychological support. When a patient’s clinical profile calls for it, treatment may include approved medication and, in specific cases of severe obesity or significant complications, surgical procedures. Decisions must always be made with professional assessment and follow-up.

“At the end of the day, the goal and the benefit are not simply to see a lower number on the scale,” Dr. Caravaca concludes, “but to address the root of the problem so that patients can achieve the main objective: living better and living longer.”