Long-term, successful weight loss continues to represent a major clinical challenge. Most studies have noted that much of the weight lost in the first 6 months is regained at 1 year. The therapeutic options to achieve successful weight loss are limited because some of the medications that can promote weight loss are contraindicated in patients with CAD. To date, the only weight-loss strategy with effective long-term results is bariatric surgery. Observational studies have shown signifi- cant improvements in cardiometabolic parameters, quality of life, and cardiac mechanics following major weight loss after Many patients after CABG with a BMI of would qualify for bariatric surgery, and this thera- peutic modality may be considered for long-lasting weight Bariatric surgery has been shown to be safe in stable patients with CAD who have not had a recent MI.407 The cornerstone of the management of metabolic syndrome is lifestyle modification with increased exercise, improved diet, and weight loss. Lifestyle changes can improve all of the metabolic syndrome components. Diets low in carbohydrates can effectively improve hypertriglyceridemia. High protein intake, along with a high consumption of fruits, vegetables, and nonfat dairy products, can improve BP.408 Commonly, pharmacological treatment is needed for hypertension, diabe- tes mellitus, and dyslipidemia despite lifestyle changes. For patients with advanced degrees of obesity, bariatric surgery has been shown to significantly reduce the prevalence of meta- Obesity and Metabolic Syndrome Recommendations 1. The assessment of central distribution of fat is rea- sonable in CABG patients by measuring waist and hip circumference and calculating waist-to-hip ratio, even if the BMI is within normal limits (Class IIa; Level of Evidence C). 2. Bariatric surgery may be considered for CABG patients with a BMI >35 kg/m2 if lifestyle interven- tions have already been attempted without meaning- ful weight loss (Class IIb; Level of Evidence C). 