About the consensus statement

Executive Summary

This report presents the findings of an evidence review and environmental scan undertaken to inform the management of obesity within the context of cardiovascular disease (CVD). The evidence review aimed to synthesise current scientific literature on the diagnosis, assessment, and treatment of overweight and obesity, with a particular focus on their relationship to CVD and associated cardiometabolic risk factors. Complementing this, the environmental scan examined the Australian health system to identify existing policies, programs, and structural enablers and barriers that influence the implementation and effectiveness of obesity and CVD-related interventions.

Summary of key findings

Evidence Review

Contemporary guidelines emphasise the need to move beyond BMI alone in diagnosing obesity, advocating for confirmation of excess adiposity. Individualised staging and assessment of cardiometabolic risk, alongside a holistic approach to health, are critical for accurate diagnosis and management. Obesity is a significant and independent risk factor for CVD, major adverse cardiovascular events (MACE), and mortality. However, this relationship is influenced by metabolic health, adipose tissue distribution, cardiorespiratory fitness and comorbidities such as type 2 diabetes. Behavioural interventions, particularly those involving dietary modification and structured exercise, remain foundational for the management of both obesity and CVD. Evidence supports the use of individualised prescriptions that consider sociocultural determinants, behavioural support, and long-term adherence strategies. Improvements in diet quality and exercise confer broad health benefits beyond weight loss and should be delivered through appropriately qualified professionals.

Pharmacological interventions, including GLP-1 receptor agonists, demonstrate broad cardiovascular benefits, though challenges related to adherence, cost, and equitable access limit uptake. Intentional weight loss, supported by multidisciplinary care, provides significant cardiovascular benefit, whereas unintentional weight loss may be a marker of poor outcomes in those with CVD. Preservation of lean mass through co-prescription of diet and resistance-based exercise is critical, with strategies that enhance anabolic responses, such as adequate protein intake and resistance training, central to long-term weight loss success. Importantly, weight regain following discontinuation of pharmacotherapy or other behavioural approaches is a recognised concern, particularly in the absence of sustained behavioural support.

Bariatric surgery is well supported by observational studies, demonstrating the greatest magnitude of weight loss and consistent reductions in cardiovascular morbidity and mortality among individuals with obesity. While more invasive than other approaches, short-term procedural risk is low, and current guidelines recommend its consideration following unsuccessful lifestyle and pharmacological interventions, particularly for individuals with a BMI ≥40 kg/m² or ≥35 kg/m² with obesity-related conditions.

Environmental scan

The environmental scan identified several systemic barriers to effective obesity and CVD management in Australia. Care for individuals with multimorbidities is often siloed and fragmented, with poor continuity between primary, secondary, tertiary, and community services. Long waitlists for specialist obesity services, limited integration of dietetics and exercise physiology in tertiary care, and workforce maldistribution especially in rural and remote regions further constrain service delivery. Funding models also present significant challenges, with low investment in preventive health, high out-of-pocket costs, and the absence of dedicated Medicare items for obesity treatment in general practice.

Despite these challenges, several enablers offer opportunities for improvement. Digital health innovations, including telehealth and remote monitoring, can extend workforce reach and improve access in underserved areas. Community-based care models, particularly those embedded in schools, workplaces, and faith-based organisations, have demonstrated potential for improving population health and advancing equity. State and NGO-led programs, such as “Wellness My Way” from Health and Wellbeing Queensland, are helping to fill service gaps, although awareness and referral pathways require further development. Importantly, investment in obesity prevention is economically justified, with potential to reduce long-term healthcare costs.

Weight stigma emerged as a pervasive issue, contributing to adverse mental and physical health outcomes, increased cardiometabolic risk, and premature mortality. Experiences of stigma, often beginning in childhood or adolescence, are associated with elevated cardiovascular disease risk and internalised bias, underscoring the need for inclusive, respectful care and public health messaging.

Achieving equitable cardiovascular risk reduction for Australians living with overweight or obesity requires a well-funded, integrated model of care as the default, embedding multidisciplinary support and scalable treatment options. Tailored delivery for priority populations, including First Nations peoples, culturally and linguistically diverse (CALD) communities, people with disability, those with mental illness, and residents of regional, remote, and low-SES areas, is essential to ensure access, engagement, and sustained outcomes.

In summary, the findings of this report highlight the need for a paradigm shift in the management of obesity and CVD toward integrated, patient-centred, and equity-led models of care. Clinical practice must evolve to incorporate comprehensive assessments, multidisciplinary support, and culturally safe service delivery tailored to priority populations. Policy reform is required to address funding gaps, improve access, and support long-term adherence to evidence-based interventions. Addressing weight stigma and embedding respectful, inclusive care practices will be essential to improving outcomes for Australians living with overweight or obesity both with and at risk of CVD.