Recent increases in the population with a high body mass index (BMI) mean that individuals with bariatric care needs are an emerging population. Excess weight leads to internal physiological changes, combining with external factors such as difficulties with skin hygiene, equipment and positioning, heightening the risk of skin breakdown. Most commonly these are moisture lesions and pressure ulcers, often difficult to access within skin folds. A key challenge for clinicians is the lack of a robust evidence base to guide care once breakdown has occurred. This article gives an overview of the challenges professionals face when caring for this at-risk group, including practical suggestions for care-providers. The need for further research with this under-served population is highlighted.