Purpose of Review <p>Despite major advances in the treatment and prevention of atherosclerotic cardiovascular disease (ASCVD), a substantial burden of residual risk remains Obesity has been redefined as a primary and independent drivers of cardiovascular morbidity and mortality warranting focused attention.</p> Recent Findings <p>Obesity is now recognized as a chronic disease and a central contributor to residual cardiovascular risk through mechanisms including systemic inflammation, insulin resistance, dyslipidemia, and endothelial dysfunction. This review addresses the limitations of conventional obesity management and highlights emerging pharmacological therapies targeting the underlying adiposopathy. Additionally, we examine the impact of stigma and biases as well as social determinants of health on obesity management and explore novel application of imaging, biomarkers and technology to risk stratification tools and innovative care models .</p> Summary <p>Addressing obesity as a modifiable and high-impact disease is essential to advancing ASCVD prevention and treatment.</p>