There is a need for caution in measuring blood pressure in the obese. Problems related to adequate cuff-bladder size and shape are apparent from a review of the literature. Imperfections in experiments comparing intra-arterial/indirect blood pressure measurements remain. Cuff characteristics, as well as cuff-bladder width and length, can bias measurement of blood pressure in the obese. Authoritative committee recommendations and the differing needs of blood pressure measurement in obese adults and children still need to be rationalized. Manufacturing faults of cuff bladder and cuff availability continue to be a problem for blood pressure measurement in the obese. Measurement of blood pressure in large obese and large muscular arms may require different adjustments for cuff width and arm circumference. Nomograms for adjusting blood pressure recording in the obese are inadequate. The most important adjustment for measuring blood pressure in the obese derives from choosing the correct cuff width-arm circumference (CW/AC) ratio. Such action reduces the intersubject variability of blood pressure measurement in clinical and epidemiologic studies. Past studies probably overestimated blood pressure level in the obese and so underestimated the risk of elevated blood pressure in the obese.