Clearly, further prospective studies are needed to better define which patients can be safely re- ferred for bariatric surgery, the optimal surgical techniques, and the effects on long-term outcomes. QOL and Obesity in Patients With HF Recent studies have suggested that health-related QOL is lower in obese patients with HF.230,251 Evangelista et al251 evaluated the effect of obesity on QOL (measured by the Minnesota Living With Heart Failure Questionnaire) in an ambulatory cohort of 358 patients followed up at an HF clinic. Obesity was associated with decreasing QOL, in- cluding both physical health and emotional well-being. In addition, of note, overweight women reported more im- paired QOL than men, consistent with other studies that obese women have more impaired health-related QOL than obese men.252 High body weight is a modifiable risk factor, and proper weight management could potentially improve the low QOL of obese patients with HF. Our understanding of changes in QOL with exercise in obese and overweight patients with HF was enhanced by a secondary analysis of the HF-ACTION program.202 HF-ACTION enrolled patients with NYHA class II to IV HFrEF who were able to exercise.230 At baseline, QOL as measured by the Kansas City Cardiomyopathy Ques- tionnaire was lower in the obese (not overweight) cate- gories. Aerobic exercise training was associated with a significant improvement in QOL across all BMI catego- ries, with a slightly greater degree of improvement in QOL with exercise in the more obese patients (BMI 35 Thus, exercise therapy may be a strategy to improve the QOL of obese patients with HF. 