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Obesity is linked to higher incidences of esophageal and esophago-gastric adenocarcinoma and postoperative complications. Rates of obesity are also on the rise. The aim of this study was to determine whether increasing body mass index has an impact on changes in quality of life after upper GI cancer surgery.Methods We employed The European Organisation for Research and Treatment of cancer (EORTC) health related quality of life questionnaires (QLQ C30, OES18 and STO22) filled out by patients pre-operatively and at 6 weeks, 6 months, 1 year and 2 years after treatment. The raw scores from the questionnaires were linearly transformed according to the EORTC manual for scoring. Means of the scores were calculated for oesophageal and gastric cancer resections for patients with a BMI < 25 and compared with those > 25. Differences between means were calculated using the independent t -test.OutcomeOver a four year period 49 patients underwent oesophageal resections and 73 patients had gastric resections. Median age was 67 (Range 39-85 years). 56% of patients undergoing esophagectomy were overweight (BMI 25-30) of which 16% were obese (BMI >30). Being overweight resulted in a greater decrease of physical functioning and worsening insomnia with an increase in difficulty eating compared to controls. 52% of patients undergoing gastrectomies were overweight, 12% of which were obese. For this group, being overweight resulted in worse symptoms of nausea and vomiting at 2 years compared to normal controls.ConclusionQuality of life in overweight or obese groups deteriorates for certain parameters following oesophago-gastric cancer surgery compared to normal weight. Understanding of these changes in quality of life in the overweight can improve treatment decisions for this group of cancer patients.