New guidance moves beyond ‘eat less, move more’ to manage obesity and CVD risk.
The Heart Foundation’s Australian-first clinical consensus statement on obesity and cardiovascular disease (CVD) calls for a fundamental shift in how healthcare professionals assess and manage obesity in people with established CVD or at high cardiovascular risk.
Around two thirds of Australian adults are living with overweight or obesity, with obesity having overtaken tobacco as the leading modifiable contributor to Australia’s disease burden.
Obesity is now recognised as a chronic, relapsing condition, driven by genetic, biological, environmental, behavioural, and sociocultural factors. In addition, it is a major driver of CVD and a known risk factor for several CVD subtypes including coronary heart disease, heart failure, atrial fibrillation, peripheral arterial disease and stroke. Despite this, obesity often remains overlooked when it comes to managing CVD risk.
Bridging the obesity-CVD gap
To address this, the Heart Foundation has released new clinical guidance and a suite of practice-ready tools to support healthcare professionals caring for adults with overweight or obesity who have established CVD or are at high cardiovascular risk.
Developed by a multidisciplinary national taskforce including experts in cardiology, endocrinology, general practice, bariatric surgery, allied health and public health, along with people with lived experience, the consensus statement aims to bridge what the Heart Foundation describes as a longstanding gap.
“Obesity remains under-recognised and under-treated in cardiovascular care, despite it being a major CVD risk factor alongside hypertension, dyslipidaemia, tobacco, and type 2 diabetes,” explains Professor Garry Jennings, Chief Medical Advisor at the Heart Foundation and co-chair of the national taskforce.
“Our new consensus statement places obesity firmly at the centre of cardiovascular risk management,” he says.
The statement also offers practical strategies to address weight stigma and discusses the needs of populations disproportionately affected by obesity and CVD. These include First Nations peoples, people living in rural and remote areas and those experiencing socioeconomic disadvantage.
Beyond body mass index
The statement urges healthcare professionals to move beyond body mass index in assessing weight. While its benefits lie in its ease and reproducibility, BMI has several limitations and may not be an accurate measure in some people including pregnant women and athletes.
For this reason, the statement advises complementing BMI with measures such as waist circumference, waist-to-height ratio or waist-to-hip ratio to give a better indication of cardiometabolic risk.
“Waist-to-height ratio has the benefit of being applicable across sexes and cultures, with a universal threshold of 0.5 indicating increased cardiometabolic risk,” explains Professor Jennings. “The practical translation of this for patients is to aim for a waist circumference less than half your height.”
Management – Pharmacotherapy and metabolic bariatric surgery
The new guidance reflects the rapidly evolving role of obesity management medications – GLP-1 and GIP/GLP-1 receptor agonists. While nutrition and physical activity remain foundational management strategies, these medications are playing an increasingly important role in both weight management and cardiovascular risk reduction.
“Cardiovascular outcome trials have demonstrated that in addition to clinically significant weight loss, medications like semaglutide and tirzepatide can also reduce the risk of major adverse cardiovascular events,” says Professor Jennings. “The recommendations in the consensus statement reflect these findings and help guide clinicians on the best choice of agent.”
Notably, the statement advises healthcare professionals to consider semaglutide in adults with established atherosclerotic CVD, and semaglutide, tirzepatide or liraglutide in adults with type 2 diabetes.
For people with heart failure with preserved ejection fraction and obesity, it recommends semaglutide or tirzepatide to improve symptoms and functional capacity.
The statement also includes practical advice on initiating, titrating and managing possible side effects of these medications.
Metabolic bariatric surgery remains a highly effective management option for obesity, with observational studies suggesting a reduced risk of major adverse cardiovascular events alongside significant weight loss. The statement offers practical guidance on both pre-surgical assessment and long-term follow up. The latter includes monitoring for micronutrient and vitamin deficiencies, mental health issues, gastrointestinal side effects and weight regain.
Take home message
The consensus statement emphasises that obesity and cardiovascular risk management need a lifelong approach to management. Primary healthcare professionals play a critical role, including optimising cardiovascular risk factors and promoting adherence to preventative medicines.
One of the most important messages for GPs is that obesity should be viewed through the same clinical lens as other cardiovascular risk factors.
“Like hypertension or diabetes, obesity warrants long-term management that can include both healthy behaviour changes and medications,” explains Professor Jennings.
“GLP-1 receptor agonists are an important part of the obesity management toolkit, particularly as the evidence for their benefits, beyond weight loss alone, continues to grow.”
Explore the obesity and CVD consensus statement and practice-ready tools, including a management algorithm, at hrt.how/obesityandCVD.
References
- Australian Institute of Health and Welfare. Overweight and obesity. 2026. Accessed 28 Jul 2026. www.aihw.gov.au/reports/overweight-obesity/overweight-and-obesity/contents/summary
- Australian Institute of Health and Welfare. Australian Burden of Disease Study 2024. 2024. Accessed 28 Jul 2026. www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2024
- Welsh A, Hammad M, Piña IL, Kulinski J. Obesity and cardiovascular health. Eur J Prev Cardiol. 2024;31(8):1026-1035. doi: 10.1093/eurjpc/zwae025.
- Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation. 2021;143(21):e984-e1010. doi:10.1161/cir.0000000000000973
- Yin Y, Zhang M, Cao Q, Lin L, Lu J, Bi Y, Chen Y. Efficacy of GLP-1 receptor agonist-based therapies on cardiovascular events and cardiometabolic parameters in obese individuals without diabetes: A meta-analysis of randomized controlled trials. J Diabetes. 2025;17(4):e70082. doi: 10.1111/1753-0407.70082.
- van Veldhuisen SL, Gorter TM, van Woerden G, et al. Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis. Eur Heart J. 2022;43(20):1955-1969. doi:10.1093/eurheartj/ehac071
