BACKGROUND: Over the past 20 years, surgical treatment of obesity, or metabolic surgery, has established itself as an extremely efficient and sustainable therapy for treating severely overweight patients. Compared to non-surgical weight reduction procedures, surgical techniques have been shown to be superior in all studies, both in terms of short-term and long-term effectiveness. On the other hand, the invasiveness of the procedures is something that many patients view critically. PROCEDURES: Many years of experience with the two most commonly used procedures, laparoscopic sleeve gastrectomy and minimally invasive gastric bypass, show that both procedures are associated with very low morbidity. The comparatively high costs of the surgical procedure are more than offset by the long-term savings in other therapeutic needs (diabetes mellitus, hepatic steatosis, arthritis, osteoarthritis, etc.). The S3 guideline for carrying out metabolic surgical procedures has clear specifications for the criteria to be met. Embedding in a multi-modal concept both pre- and post-operatively is obligatory. The following article provides an overview of the indications, treatment, and aftercare in the field of metabolic surgery.