Obesity in CKD: Core Curriculum 2026.

Obesity is a chronic disease the requires lifelong care. The prevalence of obesity has surpassed diabetes and hypertension and is now the most common risk factor for chronic kidney disease (CKD) and its progression. Excess weight not only increases CKD risk but also heightens the risk for heart failure, sleep apnea, steatotic liver disease, osteoarthritis, and a myriad of other chronic conditions. The interplay between obesity, kidney, cardiovascular, and metabolic health has been termed the cardiovascular-kidney-metabolic syndrome. However, obesity is not just a driver of cardiovascular events because it also increases the risk of multiple types of cancers, osteoarthritis, and inhibited physical functioning. Among patients with kidney failure, obesity poses challenges to dialysis treatments, precludes access to transplantation, and contributes to frailty. Helping patients safely achieve and maintain weight loss could have cascading positive effects on kidney health and overall well-being. Medical and surgical therapies now provide clinicians with opportunities to treat obesity, but such treatments need to be coupled with team-based approaches. In this Core Curriculum, we provide a review of the diagnosis of obesity and its surrounding controversies, and we outline steps for obesity management in the setting of CKD.