Metabolic bariatric surgery (MBS) surgically alters the quantity, location, and pathway through the intestine, activating multiple mechanisms, including gut hormone changes, vagal nerve, biliary, and microbial alterations, with a collective result in profound metabolic improvement. It is the most effective and durable treatment for severe obesity and its >200 associated comorbidities, including type 2 diabetes, cancer, cardiovascular disease, and liver disease. Physician assistants (PAs) are integral across the entire continuum of care for the bariatric patient, including intraoperative first assisting (laparoscopic/robotic), inpatient hospitalist care, and maintenance care in the office setting with preoperative preparation, postoperative follow-up, nutritional monitoring, and complication management. Obesity is a chronic, relapsing disease driven by multiple complex causes, which is characteristic of our nutrient, living, and physical environments. Multiple effective therapies must be used in conjunction with metabolic bariatric surgery to achieve and maintain a healthy weight, avoid co-morbidities, and extend life. Healthy diets, routine exercise, psychological support, and the use of weight-altering medications are all needed in conjunction with MBS. Historically, multiple types of bariatric surgery have been performed, but understanding the most common MBS surgeries, such as the gastric sleeve, gastric bypass, and single-incision duodenal switch, is imperative to the success and health of our patients. The bariatric physician assistant must understand the preoperative preparation, interoperative techniques, and postoperative care, including complications and nutritional treatment of the bariatric patient, to deliver optimal, comprehensive, lifelong care to the MBS patient.