ABSTRACT Obesity is a prevalent chronic disease. The management of extreme obesity – i.e., body mass index (BMI) ≥ 50 kg/m2 or obesity class IV and V – is still far from ideal. Individuals with extreme obesity have a high risk of surgical complications, mortality, comorbidities, and reduced weight loss following bariatric surgery. Although lifestyle changes and anti-obesity medications are recommended for all patients with extreme obesity as adjuvants to weight loss, these measures are less effective than bariatric surgery. […]