Objective To observe the effect of Fangji Huangqi decoction on physical aesthetic indicators in patients with obesity and hypertension. Methods A total of 86 patients with obesity and hypertension admitted to Runzhou District Liming Community Health Service Center from February 2024 to February 2026 were selected. According to the random number table method, they were divided into the control group and the observation gr oup, with 43 patients in each group. The control group received conventional antihypertensive therapy together with health education intervention on diet and exercise, and the observation group was additionally treated with Fangji Huangqi decoction on the basis of the control group. The physical aesthetic indicators, blood pressure indicators, treatment effect, body satisfaction and adverse reaction rate were compared between the two groups. Results After treatment, the body weight, BMI and waist-hip ratio in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group (P <0.05). After treatment, the systolic blood pressure and diastolic blood pressure in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group (P <0.05). The total effective rate of the observation group (93.02%) was higher than that of the control group (74.42%) (P <0.05). After treatment, the total score of body satisfaction in the observation group was higher than that in the control group (P <0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion For patients with obesity and hypertension, Fangji Huangqi decoction can effectively reduce body weight, BMI and waist-hip ratio, improve physical aesthetic indicators, and exert synergistic auxiliary antihypertensive effect. It has definite overall efficacy and favorable safety, and can achieve high body satisfaction among patients.