Obesity is a serious problem facing patients and healthcare providers around the globe. Bariatric surgery has been an increasingly popular choice in the management of obesity, and the last five years have seen an enormous amount of research on the various procedures. Recently bariatric surgery has been recognized as an important modifier of the metabolic and hormonal states associated with obesity’s comorbidities. Consequently, research regarding the effect of bariatric procedures on type 2 diabetes mellitus, dyslipidemia, and the inflammatory state has become more plentiful. As bariatric surgery has matured, a growing body of evidence and experience has accrued. A change in the relative popularity of the four major laparoscopic bariatric procedures; sleeve gastrectomy, roux-en-Y gastric bypass, adjustable gastric band, and biliopancreatic diversion with duodenal switch has taken place. This has been driven by technical factors, as well as the individual procedures’ efficacy in weight-loss and improvement in comorbidities. Weight recidivism is an increasingly recognized problem as patients are followed for longer periods following their bariatric operations. This important and costly problem has roots in both technical and patient related factors.