Obesity is an increasingly common comorbidity at the time of kidney transplantation. Obesity is also a frequent complication of kidney transplantation. The obese transplant recipient suffers adverse metabolic and cardiovascular consequences of obesity. These metabolic and cardiovascular sequelae of obesity are major contributors to morbidity and mortality after kidney transplantation. We discuss the epidemiology and pathophysiology of obesity in the kidney transplant recipient and provide an overview of clinical studies on obesity in kidney transplantation. An approach to obesity in renal transplantation, based on the evidence to date, is presented.