Obesity is a global epidemic and as dangerous as smoking for how easy it is to eat bad food. Its detrimental effects on glucose metabolism, fat storage and weight gain are well known. Obesity, however, also impairs renal function, causes steeper serum creatinine spikes than in non-obese patients and worsens the outcomes of renal transplantation. Medical weight loss therapy is not feasible or easily followed by patients, so that estimated weight loss is always disappointing. Bariatric surgery and, in particular, the recently introduced laparoscopic sleeve gastrectomy procedure has become the best medical treatment for short- and long-term weight loss in chronic kidney disease patients living with obesity.