According to the World Health Organization (WHO), over 500 million adults are obese. Obesity contributes to a range of harmful comorbidities and its economic burden approximates $150 billion dollars per year. Bariatric surgery remains a gold-standard treatment of morbid obesity and is effective at reducing weight, along with obesity-related conditions. Despite the prevalence of obesity and the proven efficacy of surgery, few who qualify ultimately receive this intervention, and surgery has associated risks. Endoscopic bariatric therapy is an alternative offering a less invasive, possibly cost-effective approach for patients who otherwise would not qualify for, or who are hesitant about or do not have access to, surgical bariatric therapy. An estimated 78% of Veterans are overweight or obese, however Veterans Affairs (VA) medical centers perform only 500 bariatric surgeries annually. If endoscopic bariatric interventions are to be increasingly utilized, it is important for the VA to understand the evidence of how they compare to surgical and pharmacologic therapies. In this review, we assess the impact of endoscopic bariatric therapies on weight loss, morbidity, mortality, and resolution of comorbid conditions compared to surgery and lifestyle modification.