Obesity is associated with increased total and CV mortality due to accelerated atherosclerosis. Structural changes in the heart including concentric LV hypertrophy and left atrial enlargement may predispose to the development of heart failure and atrial fibrillation. Bariatric surgery produces marked weight loss with reversal resolution of coronary risk factors including hypertension diabetes dyslipidemia and inflammation also significant reduction in LV mass and prevention of LA enlargement. Surgically induced weight loss is associated with 50 reduction in the risk of cardiovascular events and 10 year CV mortality.