Obesity is a chronic disease that is increasing at epidemic rates worldwide. Diet and lifestyle intervention form the basis of healthy weight management but are not effective in promoting substantial weight loss in morbidly obese individuals. Bariatric surgery can provide not only profound and sustainable weight loss but also excellent control of attendant comorbidities, particularly type 2 diabetes mellitus. Despite the high quality of evidence from numerous prospective randomised trials and cohort studies, fears and concerns regarding the safety and aggressiveness of surgery is limiting the acceptance of bariatric surgery as a viable treatment option. Newer, less invasive procedures hold promise in filling the gap between conservative and surgical therapies for weight loss.