Cardiologists See the Light on Obesity and Heart Failure

A new scientific statement from the American College of Cardiology (ACC) marks a milestone in acknowledging the importance of treating obesity in patients with heart failure. It seems that cardiologists see the light and are recognizing the importance of moving beyond diet and lifestyle advice alone. The statement concludes:

“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.”

In their conclusions, the authors note that with appropriate evaluation and treatment of obesity, “clinicians may improve quality of life, functional capacity and potentially reduce HF events.”

Acknowledging Obesity

This scientific statement is important because it directly acknowledges obesity’s role in heart failure and the importance of its treatment as a chronic disease. It contrasts, subtly but clearly, with another statement issued from the ACC at the same time: Concise Clinical Guidance on Medical Weight Management. The difference is clear in the title they gave this guidance. The emphasis is on weight loss. Not as much on obesity treatment.

In the heart failure statement it’s just the opposite – focused more on managing obesity. Weight is obviously part of the picture. But it is not the overarching theme.

Will FDA Get There?

The remaining question is whether FDA will gain better perspective on obesity and heart failure. Right now, the picture is mixed. After facing from challenges from FDA, Novo Nordisk has resubmitted its application for an expanded indication for Wegovy (semaglutide) to treat HFpEF and obesity. We expect to hear more by the end of the year. Novo is not saying much about it, perhaps because FDA has given mixed signals on this indication.

Lilly applied for a similar indication with Zepbound, but quietly withdrew its application after discouraging feedback from FDA. The hurdles are higher when agency thinking revolves more around weight loss than obesity care.

That thinking has shifted and is shifting. But this takes time.

Click here for the ACC Scientific Statement on obesity and heart failure. For further perspective, click here, here, and here.

At Midnight, Light of the Shambhala, painting by Nicholas Roerich / WikiArt

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July 11, 2025