Obesity is increasing rapidly among children and adolescents in China，which is associated with multiple obesity complications，the risk of obesity and related complications in adulthood，and reduction of life expectancy. Nowadays，no medication is approved for weight loss in children and adolescents in China. Metabolic surgery has been considered as weight loss treatment for children and adolescents with moderate to severe obesity when lifestyle interventions are ineffective. Studies in China and other countries have shown that children and adolescents with moderate and severe obesity achieved substantial weight loss after metabolic surgery，accompanied with improvement，even reversal of obesity - related complications such as type 2 diabetes，dyslipidemia and hypertension，etc. and similar perioperative complication as adults. Postoperative appropriate nutrient supplement and monitoring are beneficial to reduce the long - term malnutrition complications，and patients’mental health also need to be monitored. This article reviewed the development of metabolic surgery in children and adolescents in China and abroad，and also indications， contraindications，surgical procedures and follow-up requirements.