Obesity Management in Cardiovascular-Kidney-Metabolic Syndrome — a Narrative Review of Evidence in Type 2 Diabetes and Other Cardiovascular-Kidney-Metabolic Phenotypes

Objective: To summarize stage-based approaches to obesity management in cardiovascular-kidney-metabolic (CKM) syndrome, with emphasis on the evidence and treatment considerations relevant to cardiovascular disease, chronic kidney disease, and heart failure. Material and methods: This narrative review discusses the CKM staging framework and selected clinical guidelines, consensus documents, and clinical studies addressing obesity assessment and management. Results: Obesity management should be individualized according to adiposity, obesity-related complications, CKM stage, comorbidities, patient preferences, and access to treatment. Care includes nonstigmatizing communication, lifestyle and behavioral interventions, management of cardiometabolic and kidney risk, and consideration of pharmacotherapy or metabolic surgery when appropriate. In people with established atherosclerotic cardiovascular disease and overweight or obesity without diabetes, semaglutide 2.4 mg reduced major adverse cardiovascular events in the SELECT trial. In obesity-related heart failure with preserved ejection fraction, semaglutide and tirzepatide improved weight and patient-reported or functional outcomes; evidence for incretin-based treatment specifically to improve heart failure outcomes in reduced ejection fraction remains limited. Conclusions: Obesity treatment in CKM syndrome should be long-term and tailored to clinical phenotype and treatment goals. Benefits and limitations should be discussed, and evidence from one drug, dose, or heart failure phenotype should not be assumed to apply to others.