One of the arguments put forward against the primary use of β-blockers has been concern about adverse metabolic effects, such as unfavorable effects on lipids or insulin sensitivity. Another less-appreciated potential drawback is their propensity to cause weight gain in some patients. In 8 evaluable prospective randomized controlled trials that lasted ≥6 months, body weight was higher in the β-blocker than in the control group at the end of the study. The median difference in body weight was 1.2 kg (range −0.4 to 3.5 kg). A regression analysis suggested that β-blockers were associated with an initial weight gain during the first few months. Thereafter, no further weight gain compared with controls was apparent. There was no relationship between demographic characteristics and changes in body weight. Based on these observations, the first-line use of β-blockers in obese hypertensive patients should be reviewed. Obesity management in overweight hypertensive patients may be more difficult in the face of β-blocker treatment.