Large cardiovascular outcome trials demonstrate that GLP-1 receptor agonists like semaglutide consistently reduce three-point major adverse cardiovascular events in overweight patients with established heart disease, regardless of diabetes status. These medications also improve heart failure symptoms and functional capacity in obesity-related preserved ejection fraction cases. Metabolic bariatric surgery shows similar cardiovascular benefits in observational studies, with sustained weight loss of at least 10% appearing crucial for cardiovascular event reduction. This emerging evidence represents a paradigm shift in obesity treatment, revealing that modern interventions operate through organ-specific mechanisms that protect cardiovascular health independent of weight reduction alone. The traditional view positioned obesity management as merely addressing risk factors like blood pressure and cholesterol. However, these therapies appear to directly counteract obesity's pathological effects on insulin resistance, systemic inflammation, and endothelial dysfunction. While bariatric surgery data remains limited by observational study constraints, the consistent cardiovascular benefits across both pharmaceutical and surgical approaches suggest obesity treatment has evolved into legitimate cardiovascular disease prevention. This convergence of metabolic and cardiovascular medicine opens new therapeutic avenues for the substantial population facing both conditions simultaneously.