Beyond Weight Loss: A Body Composition-Guided Nutrition Framework for Functional Recovery in Heart Failure with Obesity

Heart failure (HF) and obesity commonly occur together and can worsen symptoms, physical function, and quality of life. Although weight loss may benefit selected patients with HF and obesity, body weight alone does not show whether patients are losing fat, muscle, fluid, or a combination of these. This narrative review summarizes selected evidence on nutrition therapy, weight loss, body composition, and functional outcomes in adults with HF, including studies of high-protein diets, nutritional supplements, calorie restriction, Mediterranean-style diets, and obesity pharmacotherapy. Across studies, body composition and functional outcomes have not been measured consistently, making it difficult to determine whether weight loss is associated with meaningful functional improvement. Building on this evidence and findings from the Pro-HEART trial, we propose a body composition-guided nutrition framework that considers changes in fat and lean mass alongside physical function and quality of life. The framework is conceptual and has not yet been validated. Future studies should examine whether nutrition and weight loss interventions can reduce excess fat, preserve muscle, and improve functional and patient-centered outcomes in patients with HF and obesity.