In 2012, the US Preventive Services Task Force issued a Grade B recommendation to screen all adults for obesity.301 The recommendation is con- sistent with the AHA guideline on obesity from 2013 and more recent guidance from other pro- Although there is no direct evidence that weight loss interventions among patients with acute ischemic stroke reduce risk for recurrent stroke or otherwise improve future brain health, there is clear evidence that intensive counseling can help patients achieve meaningful weight loss.281 The US Preventive Services Task Force determined that the risks for intensive counseling were small to none.300 For selected patients, pharmacotherapy and bariatric surgery also may be effective, although surgical trials typically have excluded patients with stroke. Specific benefits of weight loss among patients with ischemic stroke include improved glucose metabolism, BP, and lipid metabolism. It also has a favorable effect on obstructive sleep apnea (OSA), AF, and vascular inflammation. Screening is necessary to identify adults for referral to effective weight loss therapy. Knowledge Gaps and Future Research Treatment of overweight and obesity is a highly prom- ising intervention for primary and secondary preven- tion of stroke. The evidence for this includes the high prevalence of overweight and obesity in the general population at risk for stroke and with completed stroke, the confirmed association between increased weight and increased risk for stroke, and the favorable effect of weight reduction on vascular risk factors, including hypertension. Weight reduction would have additional potential nonvascular benefits for patients at risk for and with established cerebrovascular disease. What holds back research on treatment of overweight and obesity for stroke prevention are the cost and complex- ity of available treatments. The most effective nonsurgi- cal approaches require intensive behavioral counseling, possibly with food substitution. 