INTRODUCTION: Achalasia is a disorder leading to significant difficulty eating that typically leads to weight loss. Historically, obesity in achalasia patients is uncommon; however, with the obesity epidemic, the epidemiology of achalasia may be evolving, and treatment may need to be tailored. Few studies have investigated patient characteristics such as age and gender that predict response to therapy. There is paucity of literature studying presence of obesity in achalasia and its effect on outcomes. METHODS: This was a retrospective cohort study of patients diagnosed with achalasia on high-resolution esophageal manometry (HREM) at a tertiary care center in 1/2008 – 12/2015. Data on patient demographics, including age at diagnosis, gender, body mass index (BMI), race, and presenting symptoms were reviewed. Interventions, including botox injection, dilation, or surgery were also reviewed. For consistency, only the interventions after HREM diagnosis at a tertiary center were assessed. RESULTS: 131 achalasia patients were included. Median age at diagnosis was 58 years old with 15% being ≤ 40 years and 85% > 40 years. Median BMI was 27 (17–51) with 69% having BMI < 30 and 31% having BMI ≥ 30. Percent of male to female patients were 52% to 48%, respectively. Percent of patients who received botox injection, dilation, or surgery as first intervention were 10%, 11%, 53%, respectively. 26% did not receive any intervention. Heller’s myotomy accounted for 89% of all surgeries. Interventions in the lower BMI group were 14% (botox), 15% (dilation), and 71% (surgery) similar to 13.3%, 13.3%, 73.4%, respectively in the higher BMI group. 100% of patients in the younger group received surgery as the first intervention, while older group had 16% botox, 18% dilation, and 66% surgery. 19 patients failed initial treatment requiring a second intervention; majority (74%) had lower BMI < 30. More patients in > 40 years group failed first intervention. There was no significant difference between gender and treatment failure. CONCLUSION: Patients with achalasia underwent similar treatment(s) regardless of their BMI or gender. Younger patients underwent surgical interventions at a higher rate, primarily Heller’s myotomy. Patients with lower BMI (<30) needed a repeat intervention at a higher frequency than their higher BMI counterpart. This was true for all interventions. Factors such as BMI may play an important role in achalasia treatment outcome; however, more controlled studies are needed.