We sought to investigate the association between visceral obesity with disease recurrence and survival in early-stage colorectal cancer (CRC) patients. We also wanted to examine if such an association, if exists, is influenced by metformin use. Stage I/II CRC adenocarcinoma patients treated surgically were identified. L3 level CT VFI (visceral fat index) was used as a metric of visceral obesity and was calculated as the proportion of total fat area composed of visceral fat. N = 492. 53% were males, 90% were Caucasians, 35% had stage I disease, and 14% used metformin. 20.3% patients developed a recurrence over a median follow-up of 56 months. VFI was associated with both RFS and OS in a multivariate model, but not BMI. The final multivariate model for RFS included an interaction term for VFI and metformin (p= 0.04). Confirming this result, subgroup analysis showed an increasing VFI was associated with a poor RFS (p= 0.002), and OS (p< 0.001) in metformin non-users only and metformin use was associated with a better RFS only in the top VFI tertile (p= 0.01). Visceral obesity, but not BMI, is associated with recurrence risk and poorer survival in stage I/II CRC. Interestingly, this association is influenced by metformin use.