Bariatric surgery and endoscopic treatments are applied to achieve effective weight loss in obese patients. Endoscopic treatment options include gastric balloons, botox injection into the gastric outlet, endoscopic sleeve gastroplasty, endoscopic small bowel bypass procedures, and endoscopic duodenal mucosal resurfacing. Some of these procedures are relatively new, and clinical experience is not yet sufficient. However, for patients with advanced obesity (BMI > 40 kg/m2) and co-existing conditions such as type 2 diabetes and hypertension, who also have advanced fatty liver disease (such as steatohepatitis or compensated cirrhosis), surgical procedures like sleeve gastrectomy and gastric-intestinal bypass are effective treatment methods.