The objective of this study is to update evidence-based best practice guidelines for nursing in weight loss surgery (WLS). We performed a systematic search of English-language literature on WLS and perioperative nursing, postoperative, anesthesia, and discharge published between April 2004 and May 2007 in MEDLINE, CINHAL and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. From these, we developed evidence-based best practice recommendations from the most recent literature on nursing in WLS. We identified >54 papers; the most relevant were reviewed in detail. Regular updates of evidence-based recommendations for best practices in WLS nursing are required to address advances in surgery and anesthesiology, as well as changes in the demographics and levels of obesity in WLS patients. Key factors in patient safety include staff education, comprehensive admission assessment, patient education, careful preoperative surveillance and postoperative care, and long-term discharge follow-up.