This article describes the special needs of the critically ill morbidly obese, with a focus on the care of the postoperative obesity surgery patient. The technique of surgery is described elsewhere in this journal. Details of nursing care complicated by obesity are discussed. Environment of care modifications required for routine care of the morbidly obese in critical care are detailed. Pharmacokinetic factors to be considered are reviewed. A case study is presented to coalesce concepts presented.