Heart failure (HF) and obesity have both become major epidemics and recognized as public health problems. Obesity has known adverse effects on cardiac structure and function; therefore, it is not surprising that there is an increased prevalence and incidence of HF in obese patients. Additionally, numerous cardiovascular (CV) risk factors associated with obesity, such as hypertension, coronary heart disease, dyslipidemia, atrial fibrillation, and depression, are also known to play a role in the development of HF. Numerous studies have suggested the presence of an "obesity paradox," where obese patients with HF have a better prognosis than do lean or normal-weight HF patients. This review discusses the role of these risk factors in obese HF patients and the utility of purposeful weight loss.