A common problem, that is facing clinicians, is the difficulty in adequately comparing the impact of different dosing practices on the clinical efficacy and toxicity profile of chemotherapy in obese cancer patients. This study aimed to evaluate the toxicity profile of CAF chemotherapy administered to obese breast cancer female patients. Doses were calculated according to either the ideal or actual body surface area (BSA). Prescribing the dose based on ideal BSA resulted in much better toxicity profile without any statistical significant difference regarding treatment failure, disease free survival or overall survival. Further controlled, powered, prospective randomized trials are needed to specifically investigate the most appropriate tool for calculating the chemotherapy dosage in obese patients. Concrete efforts and substantial investment on the part of policymakers, educators, clinicians, employers, and schools to promote physical activity and healthful dietary practices as a cultural norm is of utmost importance to maintain normal body weight, and should be set as a global public health priority