In cardiovascular practice, obesity pharmacotherapy should be guided not only by BMI but also by the presence of comorbidities and overall cardiovascular risk. Current thresholds are:

• BMI 27 kg/m² with obesity-related comorbidities (e.g., hypertension, type 2 diabetes, dyslipidemia, coronary artery disease) consider initiating pharmacotherapy.
• BMI 30 kg/m², regardless of comorbidities initiate therapy.

Key Considerations for Cardiologists:

• Central obesity and waist circumference should also inform therapy decisions, especially in South Asian populations where cardiovascular risk occurs at lower BMI.
• Early pharmacologic intervention may prevent progression to heart failure with preserved ejection fraction (HFpEF), coronary artery disease (CAD), and atrial fibrillation.
• Combine pharmacotherapy with lifestyle modification for optimal weight loss and cardiovascular benefits.
• Regular monitoring of blood pressure, heart rate, and metabolic parameters is recommended, particularly when using GLP-1 receptor agonists, CagriSema, or emerging oral anti-obesity agents.

References:

• De Oliveira-Gomes D, Martinez de Majo A, Ardila-Delgado A, Inglis SS, Mandras SA, Loro-Ferrer JF, daSilva-deAbreu A.Cardio-Obesity and Therapeutic Advances: Intersections Between Excess Adiposity, Cardiovascular Risk, and Pharmacologic Interventions. Curr Atheroscler Rep. 2026;28(1):21. doi:10.1007/s11883-026-01395-2.

• Verma S, Böttcher M, Brown P, Dicker D, Rubino D, Sbraccia P, Sharma AM, et al.CagriSema reduces blood pressure in adults with overweight or obesity: REDEFINE 1. Hypertension. 2026 Feb;83(2):e26055. doi:10.1161/HYPERTENSIONAHA.125.26055.

• Anker SD, Ji X, Kindel SJ, Gulati M, Sattar N, Zamorano J, et al. iCARDIO Alliance Global Implementation Guidelines for the Pharmacological Management of Obesity. Global Cardio Obesity Guideline Consortium. 2026 Jan25. Available from:

• Kalra S, Kesavadev J, Goel R, Lakdawala M, Agrawal V, Malhotra N, etal. Burden of Obesity in India: Need for Policy Changes to Attain Highest Possible Level of Health and Well-Being. Clin Obes. 2026 Apr;16(2):e70072. doi:10.1111/cob.70072.