There are multiple studies showing benefit of both pharmaceutical agents and gastric balloons in achieving weight loss. Both strategies require significant lifestyle measures and dietary approaches to maximise the benefit. There is a lack of data using balloons with weight loss medications and lifestyle measures. some early results in studies using all 3 measures show superior results and more sustained weight loss. Interpreting results from studies is difficult. The numerical weight loss targets should be overlooked for studies showing outcomes in co-morbidities of obesity. Increasing evidence shows improvements in key co-morbidities with these interventions. Care must also be taken in using balloons as there are many now available and not all are well studied. Indications and contraindications are critical when choosing these modalities.