What are the recommendations for the recognition and treatment of obesity in patients at risk for or with established HF?
The 2013 ACCF/AHA focused update guidelines on HF acknowledge that obesity and insulin resistance are important risk factors for the development of HF and that there are no large-scale studies on the safety or efficacy of weight loss with diet, exercise, or bariatric surgery in obese patients with HF. The 2009 AHA scientific statement suggests weight loss only if the BMI is >40. The 2010 Heart Failure Society of America guidelines recommend weight loss to improve symptoms and prognosis. Caloric restriction may be reasonable in severely obese patients with the goal of weight stabilization or reduction. Additionally, in patients with diabetes mellitus, dyslipidemia, or severe obesity, specific dietary instructions are recommended.