Obesity is epidemic in the United States, 1,2 and a recent analysis of patients enrolled in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) demonstrated significantly more underweight (defined as body mass index [BMI] Ͻ18.5) and obese (defined as BMI Ͼ30) than ageand sex-matched controls from the National Health and Nutrition Examination Survey (NHANES). 3 Specifically, idiopathic PAH (IPAH) and drugs and toxins-associated pulmonary arterial hypertension (PAH) were more likely to be obese, and those individuals with connective tissue disease-associated PAH and congenital heart disease-associated PAH were more likely to be underweight. 3 These data suggest that clinicians treating patients with PAH are very likely to encounter patients who are obese or underweight. Historically, lung or heart-lung transplant has been a treatment option facing many of these patients with life-threatening right ventricular (RV) failure. With effective medical therapies for PAH, patients who might have died from RV failure may succumb to comorbidities instead, 4 and subgroups of PAH patients with portopulmonary hypertension present a growing population of potential abdominal organ transplant candidates. The ideal approach to managing patients who are underweight or obese to optimize their candidacy for abdominal organ transplant is far from clear. There is a paucity of data regarding optimal nutritional strategies in patients with PAH; most of the