Obesity in Cardiac Rehabilitation: Considerations in Offering Weight Management As Part of Cardiac Rehabilitation Programs.

Despite its relevance to cardiovascular health, obesity is rarely targeted during cardiac rehabilitation (CR). The objective of this paper was to review evidence regarding whether measures to address excess body fat should be offered as a standard component of CR for patients with obesity. We organize the paper around three themes: 1) outcomes of obesity management, 2) the complexity of obesity management, and 3) patient attitudes, experiences, and preferences. Our discussion of each theme was informed by a narrative literature review and a survey of Canadian CR healthcare providers (n=80). We consider literature regarding available approaches to obesity management including behavioural weight loss, pharmacological, and surgical treatments. We go on to assess concerns relating to the complexity of obesity intervention, and the importance of CR patients' lived experiences and goals. Finally, we summarize obesity management considerations in the context of the goals and interventions of CR. Although most (71%) CR providers support integrating obesity management into CR, there are concerns about training, weight bias, and unrealistic expectations for weight loss within time-limited programs. Efforts to incorporate obesity management into CR must address these barriers while considering evidence-based strategies to optimize treatment outcomes (e.g., adjunctive pharmacotherapy; long-term follow-up). Whether CR should offer obesity management depends on provider competency and program resources. More research is needed to clarify patient preferences and to establish the feasibility, long-term efficacy, and cost-effectiveness of obesity management approaches in CR.