There is an obesity epidemic in the Western World. Currently one in four adults is obese and three in ten children in the UK is overweight or obese [1]. The UK Foresight Study [2] predicts that if nothing is done, this figure will rise to five in ten (50%) in women by 2050. The endocrine changes induced by obesity lead to an increased incidence of endometrial cancer. The majority of women with endometrial cancer present with early disease which means that surgery will form all or part of their treatment. This presents serious challenges as these women often have associated comorbid conditions. In this article we explore the relationship between obesity and endometrial cancer and highlight the surgical challenges.