Recommendations for the Recognition and Treatment of Obesity in Patients at Risk for or With Established HF See Tables 8 and 9 for a summary of these recommen- dations. Stage A HF 1. Obesity should be controlled or avoided to prevent the development of HF along with other CVDs (Class I; Level of Evidence C). Stages B and C HF 1. Purposeful weight loss via healthy dietary intervention or physical activity for the pur- poses of improving health-related QOL or managing comorbidities such as diabetes mellitus, hypertension, or sleep apnea may be reasonable in obese patients with HF (Class IIb; Level of Evidence C). 2. Sibutramine or ephedra weight loss prepara- tions are contraindicated in HF. Use of ephedra weight-loss preparations may contribute to the development of HF and should be avoided (Class III: Harm; Level of Evidence C). No Data Weight reduction, including with bariatric surgery or weight-loss drugs such as orlistat, has not been proven to reduce the incidence or severity of HF or mortality in HF. Hyperlipidemia and HF Hyperlipidemia and Its Paradoxical Association With Clinical Outcomes in HF In the general population and in patients with atheroscle- rotic CVD, hypercholesterolemia has consistently been shown to be associated with worse outcomes, including mortality, cardiovascular events, and the development In contrast, in patients with established HF, several analyses have now demonstrated an inverse relationship between cholesterol levels and outcome. That is, low cholesterol levels have been shown to be independently associated with increased mortality and higher cholesterol levels with improved survival. 