Analysis of 2,825 patients across four bariatric procedures revealed a clear hierarchy of weight loss at 12 months: endoscopic sleeve gastroplasty achieved 14.1% total body weight loss, sleeve gastrectomy 23.6%, Roux-en-Y gastric bypass 31.0%, and biliopancreatic diversion with duodenal switch 36.8%. Procedure type emerged as the strongest predictor of outcomes, with younger age, female sex, absence of diabetes, and lower baseline BMI also favoring greater weight loss. This represents the largest real-world comparison spanning the full spectrum from minimally invasive endoscopic to highly invasive surgical approaches. The findings challenge the common practice of using excess weight loss as the primary metric, as this measure showed less distinction between procedures, particularly the two most invasive options. For obesity medicine, these benchmarks offer crucial guidance for matching intervention intensity to patient needs and expectations. The data validates the stepped-care approach while highlighting how baseline characteristics influence outcomes. However, the single-center design and 12-month timeframe limit generalizability, particularly regarding long-term durability and revision rates that distinguish these procedures over years rather than months.