OBJECTIVES:  Obesity is one of the fastest developing civilization diseases, which has a negative impact on health by increasing the risk of progressing additional diseases. Current treatment options for obesity include non-surgical treatment and bariatric surgery. The aim of this systematic review was to identify evidence of differences in efficacy between the above-mentioned methods of obesity management. METHODS:  Randomized clinical trials comparing bariatric surgery with non-surgical treatment were identified based on a Cochrane review (time frame: November 2013) and based on the own searched of PubMed (time frame: trials published after November 2013). RESULTS:  Nine RCT studies met the inclusion criteria and were allowed in the systematic review. Bariatric surgery demonstrated significantly better: BMI reduction at 1, 2 and above 3 years (MD=-5.63 (95% CI: -8.23 to -3.04), MD=-6.92 (95% CI: -8.12 to -5.72), MD=-6.45 (95% CI: -8.06 to -4.84), respectively) and weight loss: (MD=-19.35 (95% CI: -24.18 to -14.52), MD=-18.52 (95% CI: -22.99 to -14.05), MD=-18.74 (95% CI: -23.34 to -14.14), respectively) compared with non-surgical treatment. Bariatric surgery also improved some aspects related with comorbidities. Significantly more patients in bariatric group achieved diabetes remission (at 1 year complete remission: OR=14.74 (95% CI: 1.79 to 121.57), at 2 year: OR= 17.49 (95% CI: 6.76 to 45.26) and at 3+ year: OR=17.55 (95% CI: 2.17 to 142.15)), low-density lipoprotein < 100 mg/dl (result only for 1 year (OR=6.00 (95%CI: 1.34 to 26.81)) and resolution of metabolic syndrome (at 1 year: OR=2.92 (95% CI: 1.58 to 5.39), at 2 year: OR= 9.90 (95% CI: 1.80 to 54.45)). In terms of safety analysis, adverse events occurred in both groups relatively rare, numerically more frequently in the group treated with surgery. CONCLUSIONS:  Bariatric surgery is associated with a significantly better clinical results compared to non-surgical treatment.