Obesity is a growing worldwide issue affecting more than one third of North American populations. This presentation focusses on new endoscopic techniques in weight loss. Highlights of new research going forward include the development of gastric balloon, laparoscopic banding systems and the new development of endoscopic sleeve gastrectomy using the Apollo Overstich system. The sustainability of these various interventions is also discussed. The paper also highlights the problems associated with conventional open/surgical bariatric surgery and potential pitfalls in both conventional and endoscopic therapy.