More than 60 percent of adults in the United States are overweight or obese, and obese persons are more likely to be ill than those who are not. Obesity presents challenges to physicians and patients and also has a negative impact on health status. Some patients who are obese may delay medical care because of concerns about disparagement by physicians and health care staff, or fear of being weighed. Simple accommodations, such as providing large-sized examination gowns and armless chairs, as well as weighing patients in a private area, may make the medical setting more accessible and more comfortable for obese patients. Extremely obese patients often have special health needs, such as lower extremity edema or respiratory insufficiency that require targeted evaluation and treatment. Although physical examination may be more difficult in obese patients, their disproportionate risk for some illnesses that are amenable to early detection increases the priority for preventive evaluations. Physicians can encourage improvements in healthy behaviors, regardless of the patient's desire for, or success with, weight loss treatment.