Bariatric surgery should be considered for patients with severe obesity (body mass index (BMI) ≥ 35 kg/m2) and obesity-related diseases, or BMI ≥ 40 kg/m2 without obesity-related diseases. Bariatric surgery could be considered for patients with obesity (BMI ≥ 30 kg/m2) with severe obesity-related diseases not responding to medical management. The choice of bariatric procedure should be tailored to pa­tients’ needs, in collaboration with a multidisciplinary team and based on the discussion of risks, benefits and side-effects. Several procedures are currently performed in Canada (ad­justable gastric banding, sleeve gastrectomy, gastric bypass, duodenal switch and others) but variations exist. For patients with severe obesity, surgery offers superior out­comes compared to best medical management, in terms of quality of life, long-term weight loss and resolution of obesity-related diseases, especially type 2 diabetes, sleep apnea, fatty liver disease and hypertension. Laparoscopic approach should be standard and is associated, for most patients, with a low mortality rate (< 0.1%) and low serious complication rate (< 5%). Bariatric surgery improves life expectancy. Novel surgical and endoscopic approaches are being used and developed and can represent an option for specific patients.