Obesity & Cardiometabolic Health

Excess body fat, particularly fat around the abdomen, can affect your heart in several connected ways. It can raise blood pressure, make it harder for the body to use insulin, alter cholesterol levels and increase the workload on the heart. Over time, these changes can increase the risk of heart disease, even before you notice symptoms.

“Cardiometabolic health” describes these connections between your heart, body fat, blood sugar, cholesterol and blood pressure. Understanding them helps us decide what needs attention and which changes or treatments are likely to help you.

Dr. Kulin Sheth, an interventional cardiologist at Sheth Heart Clinic in Bopal, Ahmedabad, assesses excess weight and its cardiovascular consequences. You can discuss whether medical treatment for excess weight is appropriate, how your existing conditions affect the options and what follow-up would involve. Other specialists are involved when needed. The conversation should be practical and respectful, without blame about your weight.

Why belly fat matters

“Humare yahaan aksar kehte hain, ‘Khate-peete ghar ke hain.’”

It is usually said affectionately. But an increasing waistline can still deserve medical attention, even when the family sees it as a sign of good health.

Some abdominal fat lies deeper inside the body, around the internal organs. This is called visceral fat. It is biologically active: it can promote inflammation and insulin resistance, which means the body needs more insulin to control blood sugar. It is also associated with higher triglycerides and other changes that increase cardiovascular risk.

Your weight and body mass index, or BMI, offer useful information, but they do not tell the whole story. BMI cannot distinguish fat from muscle or show where fat is stored. People of Indian and other South Asian backgrounds can develop metabolic problems at lower BMI levels than conventional international thresholds suggest. Waist measurement and your overall health therefore matter alongside BMI.

“Pet badh raha hai, lekin taakat kam ho rahi hai”

Excess fat can coexist with low muscle mass and reduced strength. Doctors call this sarcopenic obesity. Your weight may change very little while your body composition and strength change.

Difficulty getting up from a chair, climbing stairs or carrying shopping bags can be a reason to assess muscle strength. These difficulties have several possible causes; they do not establish the diagnosis on their own. Assessment may include strength testing and, where needed, measurement of body composition.

This matters particularly as we grow older. A treatment plan needs to protect muscle, nutrition and everyday function while reducing excess fat. Simply eating less and watching the scale can miss this part of your health.

Several problems can develop together, and each deserves attention:

• High blood pressure: excess weight can contribute to raised BP, increasing strain on the heart and blood vessels. Hypertension treatment may still be needed while you work on weight.
• Diabetes and abnormal cholesterol: insulin resistance and changes in blood fats can increase cardiovascular risk. Diabetes and heart disease and cholesterol management need their own assessment and treatment.
• Coronary artery disease: these overlapping factors can contribute to the build-up of plaque in the arteries supplying the heart. Having excess weight does not, by itself, mean you have a blockage. Symptoms and the wider risk profile guide assessment for coronary artery disease.
• Heart failure: obesity can affect how the heart fills and pumps. In heart failure with preserved ejection fraction, or HFpEF, the pumping fraction can remain preserved while filling pressures rise and breathlessness develops. Coronary disease can coexist. A preserved pumping fraction alone does not rule out heart failure.
• Heart rhythm and sleep problems: obesity is associated with atrial fibrillation, an irregular heart rhythm, and obstructive sleep apnoea, in which breathing repeatedly pauses during sleep. These conditions can add to cardiovascular strain.

If you have been reading about semaglutide or tirzepatide, including brands such as Ozempic, Wegovy and Mounjaro, it is reasonable to ask which specialist you should consult. The first step is an assessment of your health and treatment needs. A medicine that helped a friend may not be appropriate for you.

Endocrinologists and internal-medicine specialists have an important role in medical obesity care. Cardiologists can contribute when excess weight overlaps with cardiovascular risk or heart disease. India's regulatory guidance restricts prescribing of these medicines to specified specialists, including cardiologists for certain approved indications. The exact product and reason for treatment determine which prescribing conditions apply.

A cardiology consultation is particularly relevant when you also have high BP, abnormal cholesterol, diabetes with cardiovascular risk, coronary disease or heart failure. Dr. Kulin can help assess these connections and discuss treatment suitability, including when endocrinology or another specialist's involvement is appropriate.

You do not need to arrive having chosen a medicine. Useful questions to bring are: “Would medication help in my situation?”, “How does my heart health affect the choice?” and “Who will monitor my treatment?”

A review may be useful if you have excess abdominal fat together with high BP, diabetes, abnormal cholesterol, a strong family history of early heart disease or an existing heart condition. Increasing difficulty with ordinary activity also deserves attention.

Do not assume that breathlessness is “just because of my weight.” New or worsening breathlessness, ankle swelling, reduced walking capacity or palpitations may need assessment. Loud snoring, witnessed pauses in breathing, unrefreshing sleep and daytime sleepiness can suggest sleep apnoea.

Seek emergency care for new or persistent chest pressure, severe breathlessness, collapse, or sudden weakness or difficulty speaking. Do not wait for a weight-management appointment or a WhatsApp response.

The starting point is your health history and what you are experiencing. Dr. Kulin reviews how your weight and waist have changed, symptoms, existing conditions, medicines, family history, sleep, activity, food habits and previous attempts to manage weight. If you are considering medication, the assessment also considers previous treatment responses, muscle strength, nutritional needs and factors that could make a medicine unsuitable.

Measurements may include BMI, waist circumference and blood pressure. Blood glucose or HbA1c and a lipid profile help identify overlapping risks. Other tests are selected when the history, examination or treatment plan gives a reason for them. Thyroid or other hormonal testing is considered when clinically indicated.

Bring any recent blood tests, relevant heart reports and a complete medicine list, including supplements or previous weight-management prescriptions. This helps avoid unnecessary repetition and makes the discussion more useful.

There is no compulsory cardiac-test package for everyone with excess weight. An ECG, echocardiogram or further investigation is advised when it can answer a relevant clinical question. Existing reports are useful to bring to your cardiology consultation.

“I have tried changing my food and walking. What else can help?” This is a reasonable medical question. Obesity can need treatment beyond advice to eat less and exercise more. Prescription medicines may be appropriate when excess weight, related complications and expected benefits justify them, alongside nutritional and activity support. You do not have to view medication as a personal failure.

Selection considers your cardiovascular health, diabetes, other conditions, current medicines, nutritional status, preferences and ability to continue follow-up. Someone with established coronary disease may face a different decision from someone with obesity-related heart failure or someone without either condition.

Ozempic, Wegovy and Mounjaro: understanding the names

Brand names and medicine names can be confusing. The distinction matters when discussing eligibility and expected benefits.

Semaglutide is a GLP-1 receptor agonist. Tirzepatide acts on both GIP and GLP-1 receptors. They influence appetite and metabolic regulation, helping some people reduce food intake and manage excess weight. Product formulations, doses, approved uses and prescribing conditions differ. Do not switch or combine them yourself.

Could I be eligible if I do not have diabetes?

Possibly. Some medicines have approved weight-management uses in people without diabetes. Eligibility depends on the specific product's approved criteria, weight-related complications, medical history and expected balance of benefit and risk. An Indian guideline's criteria for considering obesity treatment are not automatically the same as every medicine's approved prescribing criteria.

Someone with an increased waistline may need cardiovascular risk assessment even when medication is not indicated. An assessment should end with a clear explanation of the options, whether that means medication, nutritional and activity support, specialist referral or a combination.

What is the evidence for heart benefit?

The evidence depends on the medicine and the condition being treated.

In SELECT, semaglutide reduced major cardiovascular events in people with overweight or obesity and established cardiovascular disease who did not have diabetes. This does not establish the same benefit for every person with excess weight.

In SUMMIT, tirzepatide improved health status and reduced the combined outcome of cardiovascular death or worsening heart failure in people with obesity and HFpEF. The result was driven mainly by fewer worsening-heart-failure events, rather than a demonstrated reduction in cardiovascular deaths alone.

In SURPASS-CVOT, involving people with type 2 diabetes and established cardiovascular disease, tirzepatide met the trial's criterion for being no worse than dulaglutide for the combined risk of cardiovascular death, heart attack or stroke. It did not demonstrate superiority for that primary outcome.

These findings help guide individual treatment decisions. They do not replace established treatment for coronary disease, heart failure, BP or cholesterol.

Safety and long-term planning

Nausea, vomiting, constipation or diarrhoea can occur, particularly during treatment initiation or dose changes. Persistent vomiting, inability to keep fluids down or severe, persistent abdominal pain needs prompt medical advice.

Before treatment, your prescriber reviews pregnancy plans, breastfeeding, previous pancreatitis or gallbladder problems, significant digestive symptoms, allergies and relevant personal or family history. A personal or family history of medullary thyroid carcinoma, or having multiple endocrine neoplasia type 2, must be specifically discussed because it can affect treatment eligibility; the chosen product's prescribing information guides the decision. This is a specific history, distinct from common hypothyroidism. Weight-management medicines are not used to pursue weight loss during pregnancy.

Diabetes medicines may need adjustment to avoid low blood sugar. Follow-up also checks nutrition, hydration, strength and tolerability. Never start, share or change doses using someone else's prescription.

Obesity often needs long-term management. Weight regain after stopping medication is common, so discuss continuation and any planned withdrawal from the outset. The decision to continue, change or stop treatment depends on benefit, safety, the product's prescribing information and your circumstances. Before starting, agree who will prescribe, when reviews will take place and whom to contact if problems develop.

The most useful plan is one that fits your health, food preferences, work and family life. Goals are agreed individually and reviewed over time.

Make familiar meals work better for you

“Ghar nu khavanu chhe, toh problem shu chhe?” Home-cooked food can be nutritious, but portions, preparation and frequent snacks still matter.

Sweetened chai with biscuits, regular farsan or fried snacks, generous oil or ghee, sweets and repeated servings of roti and rice can add more energy than you need. No single food explains a person's weight. Look at the whole day's pattern, including what is eaten between meals.

You can keep familiar Gujarati foods while adjusting portions, cooking methods and the balance of the meal. Include vegetables and appropriate protein sources such as dal, beans, curd, tofu or other foods you eat. Whole fruit is generally preferable to juice. A dietitian can help turn broad advice into meals that suit your household.

Build activity and protect strength

Walking is valuable. Break up long periods of sitting and build activity gradually. Suitable strength exercises help preserve muscle, alongside adequate nutrition. Your starting point depends on symptoms, fitness, joint problems and any existing heart condition; someone recovering from a cardiac event may need supervised rehabilitation.

Avoid crash diets or severe restriction, especially if you are older, losing strength or taking medicines that can lower blood sugar. Protein advice should also account for kidney disease and other medical needs.

Treat the risks you already have

Weight management complements treatment for BP, cholesterol and diabetes. Continue prescribed medicines unless your treating clinician changes them. Tobacco cessation, adequate sleep and treatment of sleep apnoea where present are also important parts of cardiovascular care.

Cardiology care addresses your cardiovascular risk, symptoms and heart conditions. A primary physician or diabetologist/endocrinologist may coordinate broader metabolic treatment, while a dietitian helps with food choices and nutrition. Suspected sleep apnoea may require a sleep specialist.

Metabolic or bariatric surgery can be an appropriate option for selected people with obesity and related health problems. It deserves a balanced specialist discussion rather than being automatically dismissed or recommended. The surgical team assesses eligibility and long-term nutritional needs; the cardiologist contributes cardiovascular assessment and management when required.

Coordination helps keep the different parts of your treatment working together.

How progress is reviewed

Your follow-up looks beyond kilograms. Waist and weight trends are considered alongside BP, glucose, cholesterol, symptoms, walking capacity, strength, food intake and any medicine side effects.

The plan may need adjusting if appetite falls too much, strength declines, dizziness develops or blood sugar runs low. In people with heart failure, a rapid weight increase with swelling or breathlessness may reflect fluid retention and needs assessment rather than stricter dieting.

The aim is sustainable improvement in health and everyday function. There is no single target weight that is right for every patient.

You may want help understanding whether a weight-management medicine is appropriate, how your heart condition changes the choice, whether symptoms need further investigation or when another specialist should be involved.

Dr. Kulin personally reviews available reports and relevant images before deciding what additional assessment, if any, is appropriate. Bring your medicine list and previous treatment details to a second-opinion consultation. The discussion can help clarify the options and coordinate the next steps with your treating team.

Clinical references

• Ministry of Health and Family Welfare: Specialist prescribing conditions and regulatory surveillance of GLP-1 medicines, March 2026

• Wegovy: Indian prescribing information, including weight-management and cardiovascular indications

• Lilly India: Mounjaro authorisation and indications in obesity and type 2 diabetes

• Abbott and Novo Nordisk India: Semaglutide products and the Ozempic diabetes indication

• Endocrine Society of India: Clinical practice guidelines for the evaluation and management of obesity in India, 2025 update

• Endocrine Society of India and Obesity Surgeons Society of India: Joint treatment algorithm for patients with obesity in India, 2026

• American College of Cardiology: Medical weight management for optimisation of cardiovascular health, 2025

• American College of Cardiology: Management of obesity in adults with heart failure, 2025 scientific statement

• SELECT trial: Semaglutide and cardiovascular outcomes in obesity without diabetes

• SUMMIT trial: Tirzepatide for heart failure with preserved ejection fraction and obesity

• SURPASS-CVOT: Cardiovascular outcomes with tirzepatide versus dulaglutide in type 2 diabetes

• ESPEN and EASO: Definition and diagnostic criteria for sarcopenic obesity

• ICMR–National Institute of Nutrition: Dietary Guidelines for Indians, 2024

• Semaglutide: Prescribing information and medication safety, DailyMed

• Tirzepatide: Prescribing information and medication safety, DailyMed