Objective To explore the effect of traditional Chinese medicine prescriptions on body mass index (BMI) and waist-to-hip ratio in patients with cardiogenic obesity. Methods A total of 80 patients with cardiogenic obesity admitted to the People's Hospital Afffliated to Fujian University of Traditional Chinese Medicine from January to October 2025 were selected, and they were divided into the reference group and the study group by the random number table method, with 40 patients in each group. The reference group received conventional western medicine treatment, and the study group was treated with conventional western medicine combined with traditional Chinese medicine prescriptions. The BMI, waist-to-hip ratio, cardiac function indicators and adverse reaction rate were compared between the two groups. Results After 8 weeks of treatment, the BMI, waist circumference, hip circumference and waist-to-hip ratio in the study group were lower than those in the reference group (P<0.05). After 8 weeks of treatment, the LVEF in the study group was higher than that in the reference group, and the LVEDD was lower than that in the reference group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Combined application of traditional Chinese medicine prescriptions and conventional western medicine for patients with cardiogenic obesity can reduce BMI and waist-to-hip ratio, improve cardiac function, without increasing the incidence of adverse reactions. It is worthy of clinical application.