Doctor measuring obese man stomach.

(© Kurhan -

ROCHESTER, Minn. — It’s no secret that obesity affects the heart, but it might be an even bigger problem than people think. A recent review explain how obesity can impact common tests doctors use to diagnose heart disease and treat cardiovascular problems — making it more difficult to provide care for those most vulnerable to health issues.

“Excess fat acts as a kind of filter and can skew test readings to under-or overdiagnosis,” says senior author Francisco Lopez-Jimenez, M.D., director of preventive cardiology at the Mayo Clinic. “Obesity affects nearly all the diagnostic tests used in cardiology, such as ECG, CT scan, MRI and echocardiogram.”

Cardiovascular disease remains the leading killer in the United States, despite it being highly preventable for most people. Common interventions, like stent placements through the leg — which opens narrowed arteries — or heart surgery, can be more difficult to successfully perform in patients with significant obesity. These procedures also come with increased risks in this patient group, such as infections at the wound site.

Some drug interventions may have to be individually tailored based on obesity status as well. Beta-blockers, for example, also could prevent some patients from losing weight, which can further complicate things for patients who may need or want to reduce their body fat. In light of this, alternatives are necessary for this patient population.

“Obesity is an important risk factor to address in patients with heart disease and it requires us to do something,” says Dr. Lopez-Jimenez in a media release. “The patient needs to know that their clinician can help them lose weight. Overall, weight loss solutions come down to finding the right therapy for the patient.”

Obese, overweight woman measuring her waist size
(© spaskov –

Heart patients in particular can struggle with weight loss because of their symptoms. Shortness of breath is very common even when simply walking up the stairs, let alone exercising. This can make patients feel averse to trying to engage in more intense physical activity, despite exercise being supportive of both their weight loss and heart health efforts.

Usually, a therapist, dietitian, and at times psychologist are all part of the interdisciplinary team to help patients lose weight in a standard program. In more dire cases, bariatric surgery and weight loss-specific medications are options for patients, but they come with both risks and rewards.

“In general, patients with heart disease and a particularly advanced degree of obesity will benefit from trying lifestyle modification. And if that doesn’t work, or if they have tried that in the past, it is reasonable to consider bariatric surgery or medications,” says Dr. Lopez-Jimenez.

The Mayo Clinic has just started a multidisciplinary cardiometabolic program aimed at addressing obesity and helping improve patient quality of life so that they don’t feel as defeated by their condition. Something similar would be of great benefit to people across the country, given how common heart disease is. In light of this, other medical facilities could possibly consider starting programs like this to support their patients.

The review is published in the Journal of American College of Cardiology.

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About Shyla Cadogan, RD

Shyla Cadogan is a DMV-Based acute care Registered Dietitian. She holds specialized interests in integrative nutrition and communicating nutrition concepts in a nuanced, approachable way.

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