Obesity and Cardiovascular Disease: A New Australian Consensus on Managing Cardiometabolic Risk

The National Heart Foundation of Australia has released an Australian-first clinical consensus statement on obesity and cardiovascular disease (CVD), providing healthcare professionals with practical, evidence-based guidance for assessing and managing overweight and obesity in adults with established CVD or at high cardiovascular risk.

The statement represents an important shift in the way obesity is considered within cardiovascular care. Rather than viewing obesity simply as a lifestyle issue or an isolated risk factor, it recognises obesity as a complex, chronic and relapsing condition requiring long-term, person-centred management.

This is particularly relevant to cardiometabolic medicine, where obesity frequently intersects with hypertension, dyslipidaemia, insulin resistance, type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD), obstructive sleep apnoea and cardiovascular disease.

Why obesity matters in cardiovascular care

Approximately two-thirds of Australian adults are currently living with overweight or obesity. In 2024, overweight and obesity overtook tobacco use as the leading modifiable contributor to Australia's disease burden.

The relationship with cardiovascular health extends beyond body weight alone. Excess adiposity can contribute to systemic inflammation, insulin resistance and endothelial dysfunction, while also increasing the likelihood of established cardiovascular risk factors including hypertension, dyslipidaemia and type 2 diabetes.

Importantly, obesity is associated with multiple cardiovascular conditions, including coronary heart disease, heart failure, atrial fibrillation and stroke.

The Heart Foundation statement therefore encourages clinicians to consider obesity management as part of a broader strategy to reduce long-term cardiovascular and cardiometabolic risk.

Moving beyond BMI alone

BMI remains a useful clinical screening tool, but the consensus statement highlights the importance of looking beyond BMI when assessing an individual's health risk.

Additional assessment of adiposity — including measures such as waist circumference and waist-to-height ratio — can provide further information about central adiposity and cardiometabolic risk.

This is particularly important because individuals with a BMI within the traditionally defined healthy range may still have elevated body fat or central adiposity associated with adverse metabolic and cardiovascular outcomes.

Clinical assessment should therefore consider the broader picture, including:

BMI and measures of central adiposity

blood pressure

lipid profile and other cardiovascular risk factors

glucose regulation and diabetes risk

existing cardiovascular disease

associated conditions such as MASLD and obstructive sleep apnoea

physical activity and cardiorespiratory fitness

overall metabolic health.

The emphasis is increasingly on understanding the individual's cardiometabolic risk profile, rather than focusing on a number on the scales alone.

Nutrition and physical activity remain foundational

Nutrition, physical activity and sustainable behavioural change remain fundamental components of obesity management and cardiovascular risk reduction.

The consensus statement supports an individualised approach that considers a person's clinical circumstances, preferences and ability to maintain changes over the long term.

Physical activity also has benefits beyond weight loss. Improvements in cardiorespiratory fitness, metabolic health and cardiovascular risk can occur even when changes in body weight are modest.

For this reason, successful obesity management should not be measured exclusively by kilograms lost. Improvements in blood pressure, glycaemic control, lipid profile, fitness, body composition, functional capacity and quality of life may all represent meaningful clinical outcomes.

The evolving role of obesity management medications

One of the most significant developments in obesity medicine has been the emergence of newer pharmacological therapies.

The Heart Foundation statement provides practical guidance regarding when and how obesity management medications should be considered, particularly for people with established CVD or those at high cardiovascular risk.

Newer incretin-based therapies, including GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists, have substantially changed the treatment landscape. In appropriate patient groups, evidence now extends beyond weight reduction to improvements in cardiovascular outcomes.

Medication, however, is not presented as a stand-alone solution.

Pharmacotherapy should form part of a comprehensive management strategy incorporating nutrition, physical activity, management of cardiovascular risk factors and appropriate clinical follow-up.

Metabolic bariatric surgery and long-term follow-up

For appropriately selected patients, metabolic bariatric surgery remains an important treatment option.

The consensus statement addresses not only patient selection and the role of surgery, but also the importance of short- and long-term multidisciplinary follow-up.

Long-term management following bariatric surgery may include nutritional monitoring, management of cardiovascular and metabolic risk factors, assessment of weight trajectory and ongoing support to maintain improvements in health.

This reinforces a central theme of the statement: obesity requires lifelong management, irrespective of whether treatment involves lifestyle intervention, pharmacotherapy, metabolic bariatric surgery or a combination of approaches.

Treating obesity within the broader cardiometabolic picture

Perhaps one of the most important messages from the Heart Foundation statement is that obesity should not be managed in isolation.

Cardiovascular, renal and metabolic conditions frequently coexist and share common underlying risk factors. Effective management therefore requires clinicians to identify and address the interconnected drivers of disease.

For patients, this may mean moving away from fragmented management of individual conditions towards a coordinated model that considers weight, cardiovascular risk, metabolic health and associated comorbidities together.

A multidisciplinary approach at Cardio Metabolic Services

The recommendations outlined in the Heart Foundation consensus statement closely reflect the multidisciplinary philosophy underpinning Cardio Metabolic Services (CMS).

CMS provides a coordinated approach to the assessment and management of cardiometabolic risk, bringing together medical specialists, weight-management expertise, allied health and targeted diagnostic assessment.

Depending on individual clinical needs, assessment and management may include:

medical weight management

cardiovascular risk assessment and optimisation

lipid and metabolic risk management

body composition assessment

assessment of liver health, including FibroScan where clinically appropriate

nutrition and exercise support

identification and management of relevant cardiometabolic comorbidities

coordinated specialist and allied health care.

This integrated model enables treatment to focus not simply on reducing weight, but on improving the broader health outcomes associated with obesity.

A shift towards long-term cardiometabolic care

The Heart Foundation's new consensus statement represents an important development in Australian clinical practice.

It reinforces that obesity is a chronic condition requiring evidence-based, individualised and often multidisciplinary care — and that managing obesity can be an important component of reducing cardiovascular risk.

For healthcare professionals, it provides a practical framework for identifying risk earlier, looking beyond BMI alone, initiating appropriate treatment and supporting patients over the long term.

For patients, it represents an equally important change in conversation: successful obesity management is about improving health, not simply achieving a target weight.

Reference: National Heart Foundation of Australia. Obesity and cardiovascular disease: A clinical consensus statement. 2026.

This article is intended for general educational purposes and does not replace individual medical advice. Treatment decisions, including the use of obesity management medications or metabolic bariatric surgery, should be made in consultation with an appropriately qualified healthcare professional.