Obesity is becoming a worldwide problem of epidemic proportions, and its effect on the heart is increasingly being recognized. Obesity is often associated with an increased risk for heart failure. In this article, the authors review the evidence for obesity-related cardiomyopathy. The importance of metabolic disturbances in the development of cardiomyopathy in obese patients is highlighted. The authors also briefly explore whether obesity plays a role in the development of pulmonary hypertension. Better recognition and understanding of both obesity cardiomyopathy and pulmonary hypertension are needed in the obese patient population.