© 2020, Springer Nature Switzerland AG. Purpose of review: To provide an update on bariatric/metabolic surgery in adolescents including pre-operative multidisciplinary workup, operative options, and outcomes Recent findings: Obesity among teenagers is rising in the USA and much of the world. However, there is no one single solution to cure obesity and associated comorbidities in obese adolescents. Reasonable alternatives to surgical intervention include a multidisciplinary team effort that would consider lifestyle modifications and collaborative behavioral approaches. While this option can treat mild-to-moderate obesity, severely obese adolescents often require a more aggressive approach. To date, bariatric surgery is the best solution for morbid obesity with effective results. The most commonly performed weight loss operations are Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG). Sleeve gastrectomy is becoming the most popular procedure for teenagers with promising short-term results. However, there is no clear recommendation to support one procedure over the other long term. Summary: Effective management of obese adolescents requires early referral, a multidisciplinary team approach, and early identification of potential surgical candidates. Preventive techniques, safe pharmacological therapies, easily adopted behavioral and dietary changes, and safer and less invasive surgical techniques should be the focus of future practice. Also, long-term follow-up on adolescents’ post-bariatric surgery would provide a better understanding of this approach to adolescents in terms of comorbidity resolution, the psychosocial benefits, and the impact on life expectancy.