In the last decade there has been significant development of novel devices and techniques in the field of endoscopic bariatric and metabolic therapies (EBMTs). Bariatric endoscopy fulfills an unmet need within the current paradigm of obesity management. The expansion of this field is an important step in offering complete care to patients with obesity and metabolic disease. Nevertheless, information, mentorship and guidance through starting a practice in EBMTs are limited. We discuss important considerations when beginning a practice in obesity care with a focus on endobariatrics in a variety of practice settings.