The prevalence of obesity is increasing worldwide and across the United States. Nurses are more and more frequently faced with planning care for larger, heavier patients. The issue, most importantly, is that this special population can predispose caregivers to injury; however, failure to provide adequate patient activity and mobility leads to issues of patient safety and ultimately challenges to nurses. Patient demographics, barriers to care and the threat of caregiver injury are presented herein. Clinical challenges such as behavioral changes, pain management, skin and wound concerns, and panniculectomy surgery are discussed. Ideas for making specific changes are described, all within the context of improving clinical, cost, and satisfaction outcomes.