The link between obesity and diabetes, hypertension, and eventual kidney dysfunction is well recognized. To evaluate trends in the body-mass index (BMI) of donor nephrectomy patients, the BMI was evaluated in 532 donors over 11 years from 2002 to 2012. Measurements were made preoperatively, at 1 year, and at the present time. The follow-up range varied from 12 months to 11 years dependent on the date of donation. Of the 532 patients queried, 100 patients had long-term results. At 1 year, there was an overall decrease in BMI, however, at anytime after the first year, postoperative BMI trended upward, with more than half of the overweight patients (BMI 25-30), at the time of donation, dipping into the obese range (BMI >30). Given these results and recognizing the attendant risks-especially with the background of a single kidney-we have initiated further lifestyle and nutrition counseling at our center and are considering a more stringent preoperative weight control policy.