Whereas the initial focus of bariatric surgery primarily focused on weight loss and was considered by many clinicians and the public as a cosmetic-driven procedure, this surgical therapy is now recognized as a successful approach to reducing cardiovascular disease risk and the only substantial and sustainable weight loss treatment for most severely obese patients. In addition, as a result of the multiple metabolic-related benefits associated with bariatric surgery, efforts to understand physiologic and biochemical mechanisms have led to a dramatic increase in scientific discovery. This review focuses on bariatric research conducted during the past two decades in relation to cardiovascular disease risk and the effects of this surgical therapy on diabetes. Cardiovascular and diabetes mortality and morbidity associated with bariatric surgery are reviewed. The opportunity for bariatric (and/or metabolic) surgery to provide a preventive strategy for cardiovascular disease and diabetes as well as treatment therapy is presented for clinical consideration.