None seem to be both safe and effective. The ones that are effective are only minimally so, and they have significant side effects and health risks. The ones that are safe don't seem to be very effective in helping folks lose weight and keep it off. In spite of a tremendous amount of research, there still is no magic pill that melts pounds away effortlessly. Obese people and their physicians had great hope for fen-phen, a combination stimulant and antidepressant, but those hopes were dashed when some of the people taking it developed potentially fatal heart problems.
New medications are available, and more are in the pipeline.
Talk to your doctor about their pros and cons. The procedure is major surgery and is associated with risk of significant side effects and complications. For this reason it should be considered a treatment of last resort. Also, to be successful, the patient must cooperate with an entirely new way of eating and managing food. If nothing else has worked for you, and if your medical situation warrants such a drastic approach, talk to your physician to see if you might be a candidate for this procedure.