Purpose of Review <p>This review explores the challenges of accurately assessing obesity in patients with liver cirrhosis complicated by ascites. It aims to clarify the limitations of traditional anthropometric methods and evaluate emerging tools that account for fluid overload and altered body composition.</p> Recent Findings <p>Recent studies emphasize that conventional indices such as BMI, waist circumference, and bioelectrical impedance are unreliable in this setting. Advanced imaging modalities, including CT, and MRI, as well as newer techniques like multifrequency BIA and muscle and fat ultrasound, added to the simple bedside skinfold thickness might improve accuracy in evaluating fat and muscle compartments despite ascitic interference.</p> Summary <p>Obesity assessment in cirrhosis with ascites requires multimodal evaluation rather than reliance on BMI. Combining ultrasound with skinfold or impedance measures provides a practical, low-cost, and reproducible approach. This integrated framework enhances diagnostic precision and offers a foundation for personalized management and future research in metabolic and nutritional assessment in liver disease.</p>