Current status and perspectives of bariatric and metabolic surgery for obesity: a narrative review

Purpose: Obesity is closely associated with type 2 diabetes, cardiovascular disease, and other metabolic disorders. Lifestyle modification and pharmacotherapy provide only limited long-term benefits, whereas bariatric and metabolic surgery has become the most effective and durable treatment for severe obesity. This review summarizes current indications, major surgical procedures, clinical outcomes, and recent global and domestic trends.Current Concepts: Current guidelines recommend surgery for patients with a body mass index (BMI) ≥35 kg/m2, or ≥30 kg/m2 with obesity-related comorbidities. In Asian populations, surgery is also indicated for patients with a BMI ≥27.5 kg/m2 who have type 2 diabetes or other metabolic diseases. Sleeve gastrectomy is technically straightforward and safe but is potentially associated with weight regain and gastroesophageal reflux disease. Roux-en-Y gastric bypass achieves durable weight loss and higher remission rates of type 2 diabetes; however, it carries risks of nutritional deficiencies and limits endoscopic access to the bypassed stomach. To address these limitations, sleeve-plus procedures and one-anastomosis gastric bypass have been developed and have shown favorable short- to mid-term outcomes, although long-term evidence remains insufficient.Discussion and Conclusion: In Korea, national insurance coverage and registry-based standardization have improved access and promoted safety, with complication and mortality rates comparable to global data. Bariatric and metabolic surgery is now established as a cornerstone therapy for severe obesity, and optimal outcomes require individualized procedure selection, structured long-term follow-up, and consideration of regional concerns such as gastric cancer surveillance.