Choosing the right operation for weight loss continues to be a challenging and subjective process. In experienced hands, most operations have the ability to be successful in providing a given patient with meaningful weight loss and impart better health through loss of adiposity, amelioration of comorbidities, and improvement of overall quality of life. Novel treatments for obesity are also on the horizon, including endoluminal sleeves, endoluminal restrictive mechanisms, intragastric balloons, gastric pacing, and variations of current procedures that target metabolic diseases. The future availability of these procedures may further complicate the decision-making process for patients and surgeons.