The IFSO Worldwide Survey 2020–2021 analyzed trends in bariatric and metabolic surgery (MBS) globally and within IFSO chapters. Fifty-seven of 74 IFSO national societies responded, with 24 reporting data from national registries. The total number of surgical and endoluminal procedures increased from 507,806 in 2020 to 598,834 in 2021. Sleeve gastrectomy (SG) remained the most performed bariatric procedure, while adjustable gastric banding (AGB) continued to decline. Despite a slight increase in 2021, the number of MBS procedures did not return to pre-pandemic levels. Thirty national societies had regional protocols for MBS during the pandemic, 61.4% used telemedicine, and only 47.3% collected mortality data. These percentages remained stable in 2021. The survey revealed regional variations. In Asia-Pacific (APC), SG increased to 70% of procedures in 2021, while in Latin America (LAC), SG became the most performed procedure for the first time. In Europe (EC), SG remained the most common procedure, though its percentage was stable or slightly decreased. In Middle East and North Africa (MENA), SG increased by 14–16% compared to 2018. In North America (NAC), SG remained stable at about 70% of procedures. RYGB and OAGB remained common procedures globally, though their numbers varied by region. The pandemic significantly impacted MBS, with a notable decrease in 2020 due to lockdowns and resource reallocation. However, by 2021, there was a partial recovery. The survey also highlighted the growing use of endoscopic procedures, such as endoscopic sleeve gastroplasty, which increased from 1531 to 2707 between 2018 and 2021. Despite this, the number of endoluminal procedures was still underestimated due to limited participation from gastroenterologists in national bariatric societies. The study emphasized the importance of standardized protocols and data collection for MBS. While the IFSO survey provided valuable insights into global trends, data quality and methodology were limitations. The survey also noted the role of telemedicine in patient follow-up during the pandemic and the increasing recognition of MBS as a life-saving procedure for patients with severe obesity. Overall, the survey confirmed that SG remains the most performed bariatric procedure worldwide, with a potential plateau in its usage. AGB is expected to decline further, and future trends may favor less invasive procedures. The IFSO survey will continue to monitor global trends in MBS.The IFSO Worldwide Survey 2020–2021 analyzed trends in bariatric and metabolic surgery (MBS) globally and within IFSO chapters. Fifty-seven of 74 IFSO national societies responded, with 24 reporting data from national registries. The total number of surgical and endoluminal procedures increased from 507,806 in 2020 to 598,834 in 2021. Sleeve gastrectomy (SG) remained the most performed bariatric procedure, while adjustable gastric banding (AGB) continued to decline. Despite a slight increase in 2021, the number of MBS procedures did not return to pre-pandemic levels. Thirty national societies had regional protocols for MBS during the pandemic, 61.4% used telemedicine, and only 47.3% collected mortality data. These percentages remained stable in 2021. The survey revealed regional variations. In Asia-Pacific (APC), SG increased to 70% of procedures in 2021, while in Latin America (LAC), SG became the most performed procedure for the first time. In Europe (EC), SG remained the most common procedure, though its percentage was stable or slightly decreased. In Middle East and North Africa (MENA), SG increased by 14–16% compared to 2018. In North America (NAC), SG remained stable at about 70% of procedures. RYGB and OAGB remained common procedures globally, though their numbers varied by region. The pandemic significantly impacted MBS, with a notable decrease in 2020 due to lockdowns and resource reallocation. However, by 2021, there was a partial recovery. The survey also highlighted the growing use of endoscopic procedures, such as endoscopic sleeve gastroplasty, which increased from 1531 to 2707 between 2018 and 2021. Despite this, the number of endoluminal procedures was still underestimated due to limited participation from gastroenterologists in national bariatric societies. The study emphasized the importance of standardized protocols and data collection for MBS. While the IFSO survey provided valuable insights into global trends, data quality and methodology were limitations. The survey also noted the role of telemedicine in patient follow-up during the pandemic and the increasing recognition of MBS as a life-saving procedure for patients with severe obesity. Overall, the survey confirmed that SG remains the most performed bariatric procedure worldwide, with a potential plateau in its usage. AGB is expected to decline further, and future trends may favor less invasive procedures. The IFSO survey will continue to monitor global trends in MBS.