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Cardiovascular disease is the leading cause of death globally and obesity is a major risk factor either directly or through its complications such as diabetes, dyslipidaemia and hypertension. While the residual risk after treating these complications is diminishing, obesity can drive risk through, for example causing systemic and paracrine inflammation. Weight loss either through dietary and behaviour change, anti-obesity medications and bariatric surgery has been shown to be beneficial in reducing risk, or in some circumstances cardiovascular events, but the experience from cardiovascular outcome trials (CVOT) of anti-obesity medications is limited and disappointing. Obesity CVOTs will be reviewed and future perspectives discussed.