The rising use of GLP-1 receptor agonists for managing glycemia and weight has sparked interest in their potential impact during surgery, prompting the need for specific guidance for anesthesiologists. Reports have suggested a potential link between these medications and delayed gastric emptying, as well as instances of gastric aspiration during anesthesia. As a result, the American Society of Anesthesiology (ASA) has issued recommendations regarding their use prior to surgical procedures. However, applying these recommendations to obese patients is challenging due to the limited evidence available and the complexities associated with visualizing gastric contents using ultrasound and managing the airway in these individuals. This article examines how these recommendations can be applied to obese patients, with a focus on special considerations such as the use of gastric ultrasound, planning for rapid induction, and metabolic management for diabetics who have stopped taking their medication. Despite the lack of strong evidence and variations in recommendations from scientific societies, we are following the ASA’s recommendations for these patients. It is recommended to discontinue GLP-1 agonists prior to surgery. If discontinuation is not feasible or if the patient exhibits symptoms of delayed gastric emptying, rapid sequence induction is advised. In cases where there are indicators of a potentially challenging airway and surgery cannot be delayed, vigil intubation is suggested. Anesthesiologists should be proficient in using ultrasound to assess gastric contents, a task that can be particularly demanding in obese patients.