The number of obese patients admitted to intensive care units (ICUs) has paralleled the exponential growth of bariatric surgery. The obese state is an independent risk factor for coronary artery disease, apart from the increased prevalence of hypertension, hypercholesterolemia, and type 2 diabetes mellitus associated with obesity. Total parenteral nutrition is used often in postoperative bariatric patients when enteral feeding is impossible. Glycemic control using intensive insulin therapy has been an important development in the care of the critically ill surgical patient. Anastomotic leak is a potentially very serious complication that may be difficult to diagnose in the morbidly obese (MO) patient. Helical CT has been helpful in identifying the post-surgical anatomy as well as many of the complications. The obese critically ill patient has traditionally been considered at increased risk of mortality due to both underlying organ dysfunction and increased difficulty encountered during routine ICU procedures.