---
title: Obesity and the heart
description: Why obesity raises the risk of heart and blood vessel disease, how it is linked to blood pressure, blood lipids and blood sugar, heart failure and atrial fibrillation, how it is assessed and which treatment approaches clinical guidelines describe.
type: disease
aliases:
  - obesity
  - overweight
  - excess weight
  - abdominal obesity
  - visceral obesity
  - central obesity
  - body mass index
  - BMI
  - obesity and heart disease
sources:
  - tier: guideline
    org: esc
    title: 2021 Рекомендации ESC по профилактике сердечно-сосудистых заболеваний в клинической практике
    year: 2022
    doi: 10.15829/1560-4071-2022-5155
    url: https://doi.org/10.15829/1560-4071-2022-5155
  - tier: guideline
    org: minzdrav-rf
    title: Ожирение
    year: 2024
    url: https://cr.minzdrav.gov.ru/view-cr/28_3
  - tier: guideline
    org: nice
    title: Overweight and obesity management (NG246)
    year: 2025
    url: https://www.nice.org.uk/guidance/ng246
  - tier: guideline
    org: esc
    title: 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
    year: 2024
    doi: 10.1093/eurheartj/ehae176
    url: https://doi.org/10.1093/eurheartj/ehae176
  - tier: guideline
    org: minzdrav-rf
    title: Фибрилляция и трепетание предсердий
    year: 2025
    doi: 10.15829/1560-4071-2025-6668
    url: https://cr.minzdrav.gov.ru/view-cr/382_2
  - tier: guideline
    org: minzdrav-rf
    title: Артериальная гипертензия у взрослых
    year: 2024
    doi: 10.15829/1560-4071-2024-6117
    url: https://cr.minzdrav.gov.ru/view-cr/62_3
  - tier: guideline
    org: minzdrav-rf
    title: Хроническая сердечная недостаточность
    year: 2024
    doi: 10.15829/1560-4071-2024-6162
    url: https://cr.minzdrav.gov.ru/view-cr/156_2
  - tier: guideline
    org: who
    title: Obesity and overweight (WHO fact sheet)
    year: 2026
    url: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  - tier: reference
    org: msd-manuals
    title: Obesity (MSD Manual Professional Version)
    year: 2026
    url: https://www.msdmanuals.com/professional/nutritional-disorders/obesity-and-the-metabolic-syndrome/obesity
  - tier: reference
    org: msd-manuals
    title: Obesity (MSD Manual Consumer Version)
    year: 2026
    url: https://www.msdmanuals.com/home/disorders-of-nutrition/obesity-and-the-metabolic-syndrome/obesity
sources_checked: 2026-10-14
review: null
---

Obesity is a chronic disease in which excess fat tissue builds up in the body. It is one of the main risk factors for type 2 diabetes and for diseases of the heart and blood vessels.<Cite n={2} /> Obesity results from complex interactions between living conditions, psychological and social influences and biological susceptibility.<Cite n={8} /> It is not solely an individual responsibility: eating and physical activity are strongly shaped by the environment and society, which often limit the choices people have.<Cite n={8} />

This article is about what obesity does to the heart and blood vessels. The related conditions are covered in more detail in the articles on [high blood pressure](../hypertension/), [dyslipidaemia](../dyslipidemia/), [diabetes and the heart](../diabetes-and-heart/), [heart failure](../heart-failure/) and [atrial fibrillation](../atrial-fibrillation/).

<Diagram name="obesity-and-heart">
  <p slot="normal">
    The diagram shows the abdominal organs, the heart and three risk factors for heart and blood
    vessel disease: blood pressure, blood lipids and sugar metabolism.<Cite n={2} /> Here there is
    no excess fat inside the abdomen; blood pressure, blood lipids and blood sugar are normal, and
    the heart works without extra load.
  </p>
  <p slot="disease">
    In obesity, fat also builds up inside the abdomen, around the organs.<Cite n={[1, 10]} /> It
    plays a key role in raising blood pressure and in
    disturbing blood lipids and sugar metabolism.<Cite n={2} /> Through these and other mechanisms,
    obesity raises the risk of heart and blood vessel disease, including heart failure and atrial
    fibrillation.<Cite n={1} />
  </p>
</Diagram>

## Why it happens

<Patient>

Obesity has many causes. Besides the gap between how much energy a person takes in with food and how much they use, hormonal and nervous regulation and living conditions play a part.<Cite n={2} /> High-calorie food and an inactive lifestyle are among the most important causes.<Cite n={2} /> Genes affect appetite and where body fat is stored.<Cite n={10} />

Visceral fat, the fat inside the abdomen around the organs, is particularly important for the heart (it is shown in the diagram above); this fat is more harmful than fat under the skin.<Cite n={[1, 10]} /> Obesity affects the heart and blood vessels in several ways:

- it raises blood pressure; when weight goes down, blood pressure goes down too, and blood pressure medicines work better;<Cite n={6} />
- it disturbs the levels of cholesterol and other blood fats, which speeds up atherosclerosis and raises the risk of coronary heart disease and stroke;<Cite n={[9, 10]} />
- it raises the risk of type 2 diabetes;<Cite n={2} />
- it raises the risk of heart failure;<Cite n={[7, 10]} />
- it raises the risk of atrial fibrillation.<Cite n={[1, 4, 5]} />

Obesity is often accompanied by obstructive sleep apnoea, pauses in breathing during sleep: excess fat in the neck can press on the airway.<Cite n={[9, 10]} /> Sleep apnoea itself raises the risk of high blood pressure, heart rhythm problems, heart attack, heart failure and stroke.<Cite n={10} />

</Patient>

<Student>

WHO: in 2024, 1 in 7 people in the world (1.1 billion) were living with obesity; among adults aged 18 years and older, the figure was about 16%. The worldwide prevalence of obesity more than doubled between 1990 and 2024.<Cite n={8} /> According to the ESSE-RF study cited in the Russian Ministry of Health guideline, the prevalence of obesity among adults aged 25–64 years in 11 regions of Russia was 29.7%.<Cite n={2} />

ESC 2021: obesity increases CVD risk both through the major traditional risk factors and through other mechanisms; its main consequences are hypertension, dyslipidaemia, insulin resistance, systemic inflammation, a prothrombotic state, albuminuria, reduced eGFR, type 2 diabetes, and also HF and AF.<Cite n={1} /> MSD: adipose tissue is an active endocrine organ; adipokines and free fatty acids increase systemic inflammation and insulin resistance.<Cite n={9} /> Visceral adipocytes release leptin and angiotensin, and obesity-related hypertension is mediated largely by activation of the renin–angiotensin–aldosterone system.<Cite n={9} />

Russian Ministry of Health guideline: overweight and obesity are present in 25% of patients with AF; a direct correlation between the thickness and volume of epicardial adipose tissue and the risk of AF has been described, and possible mechanisms include its inflammatory effect on the atrial myocardium.<Cite n={5} /> Obesity is among the conditions with a particularly high risk of chronic HF; most patients with HFpEF have non-cardiac comorbidities, obesity among them.<Cite n={7} />

</Student>

## Symptoms

<Patient>

Obesity itself is an excess of fat tissue, and many of the complaints that come with it are caused by the conditions that accompany it.<Cite n={2} /> These can include raised blood pressure and headaches, shortness of breath on exertion and at rest, and snoring during sleep.<Cite n={2} /> Joint and back pain can also occur.<Cite n={10} />

The signs of heart conditions linked to obesity are described in the articles on [heart failure](../heart-failure/) and [atrial fibrillation](../atrial-fibrillation/).

</Patient>

<Student>

The Russian Ministry of Health guideline also lists increased sweating, menstrual disorders in women and reduced potency in men among the complaints caused by obesity-associated conditions.<Cite n={2} /> MSD: obstructive sleep apnoea in obesity often goes undiagnosed.<Cite n={10} />

</Student>

## How it is diagnosed

<Patient>

The doctor measures height and weight and calculates the body mass index (BMI): weight in kilograms divided by the square of height in metres.<Cite n={8} /> Waist circumference is measured too: it helps estimate how much fat there is inside the abdomen.<Cite n={[2, 10]} /> BMI is a practical measure, but it does not directly measure fat inside the abdomen, so it is interpreted with caution.<Cite n={3} /> BMI is not used to diagnose obesity in older people, athletes, people with a lot of muscle, pregnant women or people with marked swelling (oedema).<Cite n={2} />

To assess the heart and blood vessels, the doctor asks whether blood pressure has ever been raised and whether there has been a heart attack or stroke.<Cite n={2} /> Blood pressure is measured with a cuff that fits the size of the upper arm.<Cite n={2} /> Blood tests check cholesterol and triglycerides, glucose and glycated haemoglobin (HbA1c).<Cite n={2} /> Doctors also look for other common companions of obesity, such as sleep apnoea, fatty liver disease and depression.<Cite n={9} /> People with high blood pressure, coronary heart disease or heart failure have an ECG and/or echocardiography.<Cite n={2} />

</Patient>

<Student>

WHO: overweight is a BMI ≥25 kg/m², obesity a BMI ≥30 kg/m².<Cite n={8} /> Russian Ministry of Health guideline: the diagnostic criterion is a BMI ≥30 kg/m².<Cite n={2} /> NICE defines obesity classes: class 1, BMI 30–34.9 kg/m²; class 2, 35–39.9 kg/m²; class 3, 40 kg/m² or more. In people with a South Asian, Chinese, other Asian, Middle Eastern, Black African or African–Caribbean background, cardiometabolic risk occurs at a lower BMI, so lower thresholds are used for them.<Cite n={3} />

Waist thresholds differ between sources. Russian Ministry of Health guideline: a waist circumference ≥94 cm in men and ≥80 cm in women is the diagnostic criterion for abdominal obesity.<Cite n={2} /> ESC 2021 (WHO thresholds): at a waist circumference >94 cm in men and >80 cm in women, further weight gain should be avoided; at >102 cm and >88 cm, weight reduction is recommended.<Cite n={1} /> NICE classifies central adiposity by waist-to-height ratio: 0.4–0.49, no increased health risk; 0.5–0.59, increased health risk; 0.6 or more, further increased health risk.<Cite n={3} />

Russian Ministry of Health guideline: up to 20% of patients with invasively proven HFpEF, especially those with obesity, have natriuretic peptide levels below the diagnostic threshold.<Cite n={7} />

</Student>

## How it is treated

<Patient>

Obesity is a chronic disease: after weight loss, weight often comes back, so it needs lifelong management and follow-up.<Cite n={[2, 9]} /> Losing weight lowers blood pressure, improves blood lipids and lowers the risk of type 2 diabetes, and so lowers the risk of heart and blood vessel disease.<Cite n={1} /> Even a modest weight loss helps if it is maintained.<Cite n={[1, 9]} />

The basis of treatment is a change in lifestyle: eating habits and more physical activity. This is the first, essential and ongoing step of treatment.<Cite n={2} /> For weight to go down, the energy taken in with food has to be lower than the energy the body uses; restrictive, nutritionally unbalanced diets do not work in the long term and can be harmful.<Cite n={3} /> For the heart, a healthy diet is recommended in the long term.<Cite n={1} /> Physical activity is an integral part of treatment,<Cite n={2} /> and it is beneficial even if weight does not go down.<Cite n={3} />

If lifestyle changes are not enough, the doctor may add medicines for obesity; they are used together with diet and physical activity.<Cite n={[2, 3]} /> After such medicines are stopped, weight may come back.<Cite n={9} /> Food supplements for weight loss are not recommended: there is no evidence that they are effective or safe.<Cite n={2} />

In severe obesity, bariatric surgery is the most effective treatment.<Cite n={9} /> It is considered for people at high risk when lifestyle changes have not helped them lose weight and keep it off.<Cite n={1} /> After such surgery, conditions such as heart and blood vessel disease, high blood pressure, sleep apnoea and type 2 diabetes can improve.<Cite n={3} />

In people with obesity and atrial fibrillation, weight loss reduces symptoms and prevents the arrhythmia from coming back.<Cite n={[1, 4]} /> High blood pressure, blood lipid disorders and diabetes are treated straight away, without waiting for weight to go down.<Cite n={3} /> The doctor decides with the patient which treatment is needed; do not start, stop or change medicines on your own.

</Patient>

<Student>

ESC 2021: weight reduction is recommended in people with overweight and obesity to lower blood pressure, dyslipidaemia and the risk of type 2 diabetes (I A); maintaining even a modest weight loss (5–10% of baseline) has favourable effects on blood pressure, lipids and glycaemic control.<Cite n={1} /> Russian Ministry of Health guideline: in people with obesity, a 5–10% reduction in body weight from baseline significantly lowers the risk of cardiovascular complications.<Cite n={6} /> ESC 2024 (AF): weight loss is recommended as part of comprehensive risk factor management in overweight and obese individuals with AF to reduce symptoms and AF burden, with a target of 10% or more reduction in body weight (I B); weight reduction should be considered in obese individuals to prevent AF (IIa B).<Cite n={4} />

Russian Ministry of Health guideline: medicines registered for the treatment of obesity are recommended when non-drug treatment does not achieve clinically significant weight loss, and/or to maintain the result.<Cite n={2} /> MSD lists GLP-1 receptor agonists among medicines that mimic or enhance naturally occurring hormones regulating appetite.<Cite n={9} /> ESC 2021: anti-obesity medicines with protective effects against ASCVD may be considered.<Cite n={1} />

ESC 2021: bariatric surgery should be considered in people with obesity at high risk when lifestyle change has not achieved and maintained weight loss (IIa B).<Cite n={1} /> Russian Ministry of Health guideline: indications are morbid obesity in patients aged 18–60 years after ineffective conservative treatment, with a BMI >40 kg/m², or a BMI >35 kg/m² with severe conditions (type 2 diabetes, joint disease, obstructive sleep apnoea) whose course can be influenced by weight loss.<Cite n={2} />

ESC 2021: an "obesity paradox" has been described in patients with HF, with lower mortality at a higher BMI, but it must be interpreted with caution (reverse causation, other biases); the effects of intentional weight loss in HF remain unclear.<Cite n={1} />

</Student>

## When to call an ambulance

Obesity itself is not an emergency: if hospital care is needed for it, it is planned in advance.<Cite n={2} /> But obesity raises the risk of coronary heart disease, stroke and heart failure, which can become emergencies.<Cite n={[9, 10]} /> For chest pain or pressure, severe shortness of breath, fainting or signs of a stroke, call your local emergency number (112 in the EU, 911 in the US and Canada, 999 in the UK) at once: this is the site's general safety rule. The signs of a heart attack are described in the article on [myocardial infarction](../myocardial-infarction/), and the signs of acute heart failure in the article on [heart failure](../heart-failure/).