The bariatric patient poses unique challenges to the basic tenets of prehospital care. Airway management can be complicated; poor respiratory mechanics can predispose the bariatric patient to rapid desaturation and hypercarbia; and the patient may be at increased risk for barotrauma as a result of improper ventilator settings. Medication administration can be difficult based upon various drug dosing calculations, and even high-quality cardiopulmonary resuscitation can be hindered because of the habitus of the bariatric patient. More practically speaking, the bariatric patient can pose significant challenges to immobilization, packaging, lifting, and movement. This chapter reviews the key anatomical and physiological changes and identifies critical management considerations that the overweight patient poses to our prehospital care systems.