Background: The World Health Organization has emphasized that an increased
body mass index (BMI) is a major risk factor for non-communicable diseases (NCDs) such
as cardiovascular disease (CVD) together with diabetes, musculoskeletal disorders and some
cancers. The American Heart Association had already identified obesity as an independent
risk factor in 1995. There is a significantly increased risk of CVD independently of other
traditional risk factors (age, sex, physical activity, smoking, blood pressure and cholesterol
levels) for patients fulfilling BMI criteria of moderate overweight, which increases with the
diagnosis of obesity. Thus, both overweight and obesity are major risk factors for type 2
diabetes (T2D), hypertension, and atherogenic dyslipidemia, among others. These diseases,
when clustered, form the metabolic syndrome, a condition with exponential risk for CVD as
compared with its isolated components. In this scenario, obesity emerges as a major public
health challenge due to its huge clinical implications, taxing not only individuals but also
health-care systems and society at large.
Methods: The present review focuses on: i) the link between dysfunctional fat excess and CVD; ii) the apparent
controversies surrounding the obesity paradox as well as the concept of metabolically healthy obesity; iii) the
known beneficial effects following weight loss; and iv) available strategies to treat obesity in order to ameliorate
cardiovascular risk, which include lifestyle interventions, drug therapy, endoscopic and surgical procedures.
Conclusion: Obesity is a highly heterogeneous disease that requires customized recommendations. Weight loss in
different degrees is attainable via diverse procedures reducing morbidity and mortality while improving psychological
well-being and social function. Therapeutic strategies should be tailored to the patient’s characteristics and
need a long-term personal commitment to change.