Patients developing the short bowel syndrome (SBS) are at risk for hepatobiliary disease, as are morbidly obese individuals. We hypothesized that morbidly obese SBS individuals would be at increased risk for developing hepatobiliary complications. We reviewed 79 patients with SBS, 53 patients with initial body mass index (BMI) < 35 were controls. Twenty-six patients with initial BMI > 35 were the obese group. Obese patients were more likely to be weaned off parenteral nutrition (PN) (58% vs.
21%). Pre-resection BMI was significantly lower in controls (26 vs.
41). BMI at 1, 2, and 5 years was decreased in controls but persistently increased in obese patients. Obese patients were more likely to undergo cholecystectomy prior to SBS (42% vs.
32%) and after SBS (80% vs.
< 0.05). Fatty liver was more frequent in the obese group prior to SBS (23% vs.
< 0.05) but was similar to controls after SBS (23% vs.
15%). Fibrosis (8% vs.
13%) and cirrhosis/portal hypertension (19% vs.
21%) were similar in obese and control groups. Overall, end stage liver disease (ESLD) was similar in obese and control groups (19% vs.
11%) but was significantly higher in obese patients receiving PN (45% vs.
< 0.05). Obese patients developing SBS are at increased risk of developing hepatobiliary complications. ESLD was similar in the two groups overall but occurs more frequently in obese patients maintained on chronic PN.