The number of obese patients undergoing cardiac and noncardiac surgery is rapidly
increasing because they are more prone to concomitant diseases, such as diabetes, thrombosis,
sleep-disordered breathing, cardiovascular and cerebrovascular disorders. Even if guidelines
are already available to manage anesthesia and surgery of obese patients, the assessment of the
perioperative morbidity and mortality from heart and brain disorders in morbidly obese
surgical patients will be challenging in the next years. The present review will recapitulate the
new mechanisms underlying the Heart-brain Axis (HBA) vulnerability during the
perioperative period in healthy and morbidly obese patients. Finally, we will describe the
nutrigenomics approach, an emerging noninvasive dietary tool, to maintain a healthy body
weight and to minimize the HBA propensity to injury in obese individuals undergoing all types
of surgery by personalized intake of plant compounds that may regulate the switch from health
to disease in an epigenetic manner. Our review provides current insights into the mechanisms
underlying HBA response in obese surgical patients and how they are modulated by epigenetically
active food constituents.