Bariatric surgery is a gastro-intestinal surgery aimed at obtaining weight loss in obesity. The rapid metabolic effects of this type of operations provided a rational to change its name to metabolic surgery, in fact often the improvement of metabolic diseases is observed before a meaningful weight reduction.In this review, we examine the effects of laparoscopic metabolic surgery on life expectancy, type 2 diabetes, hypertension, cardiovascular disease and cancer.Furthermore, we review the surgical endoscopy approaches to obesity including primary obesity procedures and revision procedures that address weight regain after bariatric surgery.Finally, as a bridge to the specific chapter, we summarize the effects on weight reduction of new anti-obesity medications.