Obesity is one of the major co morbidities in patients with incisional and ventral hernias. In nearly two-thirds of our patients, we are faced with the daunting task of finding a way to help patients to overcome the challenges of managing two progressive and potentially disabling and life threatening problems. What does the evidence really say? What are surgeons really doing? What is the outlook of our current and future approaches to these twin troubles? The talk will be an exploration of this subject.