Recommendations Harmonized With Existing Guidelines There are no specific recommendations for weight loss in the 2013 ACCF/AHA focused update guidelines on but the guidelines acknowledge that obesity and in- sulin resistance are important risk factors for the devel- opment of HF and that there are no large-scale studies on the safety or efficacy of weight loss with diet, exer- cise, or bariatric surgery in obese patients with HF. In addition, the writing committee cautions against the use of ephedra, sibutramine, and other weight-loss prepara- tions because they may contribute to the development of HF and should be avoided.8 Currently, given the above concerns and the lack of evidence on intentional weight loss in HF, the 2009 AHA scientific statement on promoting self-care in individu- als with HF suggests weight loss only if the BMI is >40 If the BMI is <30 kg/m2 , weight loss is not encouraged. In the 2010 Heart Failure Society of America guide- lines, for both obesity cardiomyopathy and obesity-hy- poventilation syndromes, weight loss is recommended to improve symptoms and prognosis. Realizing that there is a paucity of data, the guidelines authors suggest that Management of Comorbidities in Chronic Heart Failure CLINICAL STATEMENTS AND GUIDELINES caloric restriction may be reasonable in severely obese patients with the goal of weight stabilization or reduc- The authors also acknowledge that for patients with HF with a BMI >35 kg/m2 , gastrointestinal surgery may be an option. Additionally, in patients with diabetes mellitus, dyslipidemia, or severe obesity, specific dietary instructions are recommended (Level of Evidence B). 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. 