Obesity has been implicated as an important risk factor for the development of gastroesophageal reflux disease (GERD). A variety of physiological abnormalities have been described which likely contribute to the association of GERD and obesity. These abnormalities involve the oesophageal body, lower oesophageal sphincter and stomach. For obese patients with GERD, weight loss in conjunction with anti-secretory medications is first-line therapy. For those with severe obesity who fail medical weight loss treatment, bariatric surgery has been shown to be beneficial. On balance, Roux-en-Y gastric bypass is probably the most efficacious surgery for patients with morbid obesity suffering from concomitant GERD.