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Rates of obesity and overweight continue to riseand substantially increase the risk of morbidityand mortality from type 2 diabetes, coronary heart disease and stroke. On the other hand, a sustained weight loss of 5–10 % in the obese confers marked health benefits. Current strategies for the management of obesity include lifestyle interventions and pharmacotherapy. At present, three drugs are approved for the medical management of obesity in the UK: orlistat, sibutramine and rimonabant. All three agents are efficacious in reducing body weight but by different mechanisms. Although weight loss is an important treatment outcome, a major goal of obesity management should be to improve cardiovascular and metabolic risk factors in order to reduce obesity-related morbidity and mortality. Given the similar levels of weight loss achievable with currently approved agents, treatment decisions should include careful assessment of the effects of these agents on cardiovascular and metabolic risk factors and on their long-term safety profiles. Br J Diabetes Vasc Dis 2007;7:268-77 Key words: lifestyle interventions, obesity, orlistat, rimonabant, sibutramine, weight management