The main goal of obesity cardiomyopathy management is to prevent and reverse the onset and progression of cardiomyopathy and to control the progression of heart failure. The only proven effective method is to reduce body mass, and early diagnosis and treatment are beneficial to improve the prognosis. Body mass reduction can be achieved through proper diet, increased exercise, adjunctive weight loss medications or weight loss surgery. A clinical benefit can be achieved with a 5-10% reduction in body mass. Overall, the degree of weight loss is proportional to the improvement in left ventricular mass and structure; reducing body mass improves left ventricular diastolic function. The same drugs that are effective in treating chronic heart failure are also indicated for heart failure due to obesity-related cardiomyopathy, including diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, beta-blockers, and digitalis drugs. In summary, obesity is an independent risk factor for cardiomyopathy, and long-term severe obesity can lead to structural and functional changes in the heart and heart failure. Hemodynamic alterations and various metabolic disorders are the pathophysiology of obese cardiomyopathy. The diagnosis is based on the signs and symptoms of heart failure with the presence of objective evidence of imaging, except for the possibility of known associated diseases. Weight loss is currently the only effective management measure.