In the July, 2015, issue of the “Journal of Arthroplasty” authors Hasham Alvi. M.D. et al from Northwestern University in Chicago, Illinois, evaluate the affect of obesity on outcomes following total joint arthroplasty. They used a Surgeon National Surgical Quality Improvement Program database of 13,250 patients. They looked at the affect of obesity on outcomes after total joint replacement. They noted that over 1/3 of the U.S. population is overweight or obese and the association between obesity and degenerative joint disease has been well documented. While obesity does not preclude functional improvement following joint replacement, it does increase the risks associated with this procedure. After reviewing the data and eliminating confounding variables. They found that a BMI equal to or greater than 40, was associated with increased risk of medical and surgical complications following joint replacement when compared to patients who were more normal weight or even those classified as overweight. This takes on increasing importance in the future when hospitals will have to pay for readmissions or postoperative complications. It will be in the hospital’s, the surgeon’s and the patient’s best interest to optimize patients prior to surgery and this includes strategies for weight loss that focus both on nutritional as well as exercise modifications and optimizing medical conditions including diabetes, hypertension, and anemia. There is increasing pressure on the healthcare system to eliminate some potentially preventable complications and this starts with optimizing the patient prior to surgery.