Abdominal wall hernias (AWH) are prevalent in patients with obesity and present a challenge in management to surgeons. Obesity is a significant factor in their development, as excess weight increases intra-abdominal pressure and abdominal wall tension. Thus, weight loss is a key factor in optimization prior to ventral hernia repair (VHR), to reduce the risk of hernia recurrence, surgical site infections, and subsequent reoperations. Multiple weight loss modalities, including lifestyle intervention, anti-obesity medications, endoscopic interventions, and metabolic and bariatric surgeries, can be utilized in the management of obesity. Among these, metabolic and bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), have been shown to be the most effective in achieving sustained weight loss and improving comorbid conditions. However, there is ongoing debate regarding the optimal timing and approach for VHR in patients undergoing bariatric surgery. In this chapter, we explore the weight loss modalities available in the optimization of patients with obesity and AWH, providing a comprehensive evaluation of their advantages and limitations. We also highlight why sleeve gastrectomy provides an optimal choice of bariatric surgery in these patients and discuss the ideal approach and timing of ventral hernia repair.