Most people in Australia are living with overweight or obesity. Obesity and its complications are associated with excess morbidity and mortality, reduced quality of life and substantial financial costs to both individuals and the healthcare system. Effective treatment options for obesity are available, and several promising therapies are currently being investigated in clinical trials.

Obesity is a complex chronic disease that is strongly associated with an increased risk of all-cause mortality. Therapies for optimising weight and metabolic health should be guided by an individual’s body mass index (with consideration of body composition), comorbidities, and the presence and severity of obesity-associated complications.

Incretin analogues are very effective weight loss medications resulting in weight loss approaching that achieved with bariatric surgery. They also have cardiovascular benefits. However, these treatments are costly and their availability has been limited because of overdemand.

Type 2 diabetes is prevalent in Australia, with most diagnosed patients also being affected by comorbid obesity. Weight loss can mitigate otherwise substantial risk in people with obesity and diabetes. Strategies for the management of weight in patients with type 2 diabetes include lifestyle modifications, pharmacotherapy and surgery.

Obesity is a major contributor to cardiovascular disease and mortality. New pharmacological treatments, including incretin therapies, have shown significant weight loss and cardiovascular benefits. Large trials have demonstrated that these agents reduce cardiovascular events in patients with cardiovascular disease and improve outcomes in heart failure, kidney disease and metabolic dysfunction-associated steatohepatitis. This article reviews the cardiovascular impact of weight loss and the role of therapies such as semaglutide and tirzepatide in reducing cardiovascular disease risk.