The incidence of super obesity, defined as a body mass index > 50 kg/m2, is rising faster than the incidence of obesity in general. Super obesity is associated with significant morbidity and mortality and surgery is the most effective therapy for treating patients with morbid obesity. There are three major types of surgery for obesity: restrictive, in which stomach size is reduced so that patients feel full after small meals; malabsorptive, in which a section of the stomach and intestine is bypassed so that fewer calories are absorbed; or a combination of restrictive and malabsorptive. Surgical treatment of obesity is complicated for patients who are super obese since they are considered high-risk candidates for standard gastric bypass surgery.