Bariatric surgery is currently the most effective therapy for the treatment of severe obesity (BMI ≥ 35 kg/m2). This article addresses psychiatric issues preceding and following this surgery, considering that weight loss is not the only criterion to be considered in assessing the quality of the postoperative course. Quality of life, the evolution of psychiatric and somatic comorbidities, compliance and long-term postoperative complications and possible interventions to optimize the psychological and psychiatric care for these patients are discussed.