Obesity has emerged as one of the most challenging public health issues of the 21st century, with its incidence continuing to rise. Bariatric and metabolic surgery (BMS), with its definitive and sustained weight loss effects as well as remarkable improvement in metabolic comorbidities, has become the most effective therapeutic approach and first-line treatment for moderate to severe obesity. Among these procedures, Roux-en-Y gastric bypass (RYGB) is one of the internationally recognized classic surgical techniques. This article systematically reviews the major advances in BMS over the past five years, covering the substantial expansion of surgical indications (including individuals with low body mass index, adolescents, and elderly patients), the evaluation and optimization of novel procedures (including one-anastomosis gastric bypass, single-anastomosis duodeno-ileal bypass with sleeve gastrectomy, and functional sleeve gastrectomy), as well as innovations in endoscopic bariatric therapies including endoscopic sleeve gastroplasty, transoral outlet reduction, the novel BARS system, duodenal mucosal surface resurfacing, are also discussed. Notably, the combined use of surgery with novel anti-obesity drugs represented by glucagon-like peptide-1 (GLP-1) receptor agonists is reshaping the landscape of obesity treatment. A 2024 network meta-analysis reported that the weight loss efficacy of tirzepatide (a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist) is approaching that of sleeve gastrectomy. Meanwhile, endoscopic sleeve gastroplasty, with its favorable safety profile, fills the gap between pharmacotherapy and surgery, though further validation through multicenter, prospective studies is still needed. In the future, BMS will evolve towards greater precision, minimal invasiveness, and integration, enabling individualized, comprehensive management of obesity through multidisciplinary collaboration.