The obesity pandemic continues, with rising prevalence reported throughout the world. In the United States, recent data show that more than two-thirds of US citizens are either obese or overweight (BMI >25 kg/m2). Approximately 33% of adults in the United States are obese (BMI >30 kg/m2), and in some areas of the country the prevalence of obesity reaches >40%.1 In Europe, obesity prevalence varies by country but ranges from 9% to 30%, and is steadily increasing.2 All of these statistics emphasize the importance of obesity and related conditions in patient care. Even in a state of relative health, obesity has major effects on cardiopulmonary physiology. ARDS continues to be both prevalent and very morbid, with an estimated age-adjusted incidence of 86.2 per 100,000 patient years, and reported in-hospital mortality of nearly 40%.3 Data from the 2009 influenza A(H1N1) pandemic suggested that patients who are obese represent a unique patient population in ARDS. Among patients with severe or fatal 2009 influenza A(H1N1), rates of severe and morbid obesity (BMI >35 kg/m2 and >40 kg/m2, respectively) were five to 15 times higher than the general population.4,5 This finding, with other data, suggests a potential link between ARDS and obesity, and at a minimum demonstrates that when critical illness is coincident with obesity, there are additional considerations for disease mechanism, management, and prognosis.6 Such inpatients are often challenging to manage due to issues including line placement, transportation, drug dosing, and imaging (Table 1).