Abstract: Obesity induced insulin resistance and meta-bolic syndrome continue to pose an important public health challenge worldwide. Metabolic surgery was developed with the aim of weight reduction. In recent years, authors have witnessed great advancement in metabolic surgery, including the development of new and safe procedures or devices. During the last decade, improvements in glycemic control and decreases in cardiovascular events and mortality after surgery have been consistently reported. Therefore, there is an urgent need to identify the type of patients that may benefit the most from metabolic surgery, morbidly obese or not, and selection criteria must be reviewed and updated based on the current surgical outcomes. This article reviews the history of metabolic surgery and summarizes the new perceptions in obesity treatment.