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For adults with advanced heart failure, class II/III obesity (body mass index ≥35 kg/m 2 ) represents major challenges, and it is even considered a contraindication for heart transplantation (HT) at many centers. This has led to growing interest in preventing and treating obesity to help patients with advanced heart failure become HT candidates. Among all weight-loss strategies, bariatric surgery (BSx) has the greatest weight loss efficacy and has shown value in enabling select patients with left ventricular assist devices (LVADs) and obesity to lose sufficient weight to access HT. Nevertheless, both BSx and antiobesity medications warrant caution in the LVAD population. In this review, the authors describe and interpret the available published reports on the impact of obesity and weight-loss strategies for patients with LVADs from general and HT candidacy standpoints. The authors also provide an overview of the journey of LVAD recipients who undergo BSx and review major aspects of perioperative protocols., Competing Interests: Funding Support and Author Disclosures Dr daSilva-deAbreu owns stocks of TransMedics Group, Inc, Annovis Bio Inc, and Altimmune, Inc. Dr Mandras has received consulting fees from and has been on the Speakers Bureau for Bayer and United Therapeutics. Dr Lavie has received consulting fees from and has served as a speaker for AstraZeneca; and has served on a DSMB for NovoNordisk on their REDEFINE 3 trial with CagriSema. Dr Ventura has received consulting fees from and has served as a speaker for AstraZeneca. Dr Schauer has consultancy agreements with GI Dynamics, Keyron, Persona, Mediflix, Metabolic Health International, LTD, Lilly, Ethicon, Medtronic, and Novo Nordisk; has ownership interest in SE Healthcare LLC, Mediflix, and Metabolic Health International LTD; and has received research funding from Ethicon and Medtronic. All other authors report that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)