Increasing overweight is a rising issue worldwide. In 2017, 17% of the Danish population had a body mass index (BMI) > 40 kg/m2 also defined as extreme obesity. Bariatric surgery is the most effective long-term treatment and the status in Denmark is summarized in this review. The most common procedures are Roux-en-Y-gastric bypass and gastric sleeve which have led to excess weight loss (EWL) up to 70%. Regardless of these results, the increasing BMI presents a problem both technically and in regard to achieving a BMI within normal range. In preliminary studies Single anastomosis sleeve ileal bypass (SASI) has shown an EWL of up to 90% and a high resolution of diabetes 2. SASI may be the future of bariatric surgery in the super obese patients