Obesity and heart failure (HF) are two intersecting public health challenges, each with rising prevalence worldwide. Obesity alters cardiac structure and function, leading to ventricular systolic and diastolic dysfunction. However, weight loss interventions, whether through lifestyle changes, pharmacological agents, or bariatric surgery, can improve cardiac function, reduce symptoms, and lower hospitalization rates. Interestingly, the "obesity paradox" suggests that HF patients with obesity may experience better survival outcomes than HF patients with normal weight despite the adverse cardiac effects of obesity. Most importantly, focusing on strategies that aim to prevent HF in patients with obesity can potentially curb the burden of this chronic condition. This review explores the complex relationship between obesity and HF, emphasizing pathophysiological mechanisms, the paradoxical survival benefit, and the impact of weight loss strategies. A deeper understanding of this relationship is critical for optimizing care and outcomes in HF patients with obesity.