The prevalence of obesity is increasing and is co-epidemic with type 2 diabetes mellitus (T2DM). Treatment of obesity has been less than adequate, particularly when managing morbidly obese patients. Research on T2DM has shown a number of new pharmacologic therapies along with the rapid employment of bariatric surgery. Improvement of T2DM, including its remission, after bariatric surgery has been recognized for more than a decade. However, not all procedures are the same. Restrictive procedures, malabsorptive procedures, or a combination of both procedures have their own categorical risks and benefits.