Obesity doubles the risk of heart failure independent of comorbidities like hypertension or coronary artery disease potentially mediated by altered hemodynamics to compensate increased mass and metabolic activity. Symptoms of obesity cardiomyopathy do not differ from other forms of cardiomyopathy, but may be easily mixed up with obesity associated symptoms. The diagnosis can be made with imaging techniques like echocardiography or magnetic resonance imaging. Therapeutic approaches include weight control by dietary intervention and exercise, as well as bariatric surgery for the morbidly obese. Heart failure treatment should otherwise follow the general heart failure guidelines.