Obesity is an epidemic disease in many countries, including Brazil. It is a multifactor disease, which depends on the interaction between genetic, behavioral and socio-cultural factors. It is important to recognize patients on risk of developing obesity and its co-morbidities in order to define objectives and improve treatment choices. The ideal weight concept must be changed to healthy weight concept. A 5 to 10% sustained weight loss has a positive effect on obese patient's health, even if the final proposed weight was not reached. The best approach is the combination of dietetic counseling and behavior changes (including physical activity) and anti-obesity medication in selected cases. No pharmacologic treatment must be used isolated. The conventional clinical treatment frequently fails in morbidly obese patients. Bariatric surgery is a safe option on these particular cases. However, the candidate to the bariatric surgery must be followed up by a multidisciplinary assistance group, even before surgery. Treatment success depends mainly on patient motivation. As obesity is a chronic disorder, treatment should be planned on a long term basis, according to the necessity of not only lose weight but also of the maintenance of this lost weight to really prevent co-morbidities. © Copyright Moreira Jr. Editora. Todos os direitos reservados.64SPEC. ISS.4149World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a World Health Organization Consultation. Geneva: World Health Organization. 2000256. WHO Obesity Technical Report Series, no 894Diretrizes brasileiras de Obesidade, Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica, 2007I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome metabólica. Rev Soc Brás Hipert 200417(04)Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Health CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999341:1097-105Zamboni, M., Armellini, F., Milani, M.P., Evaluation of regional body fat distribution: Comparison between W/H ratio and computed tomography in obeses women (1992) J Intern Med, 232 (4), pp. 341-347Geloneze, B., Repetto, E.M., Geloneze, S.R., Picolo, M., Cruzes, G., Tambascia, M.A., Hypertriglyceridemic waist: A useful tool to assess insulin resistances clinical practice (2002) Diabetes, 51 (SUPPL. 2), pp. A531Aronne, L.J., Obesity as a disease: Etiology, treatment, and management considerations for the obese patient (2002) Obes Res, 10 (SUPPL. 2), pp. 95S-96SPi-Sunyer, F.X., A review of long-term studies evaluating efficacy of weight loss in ameliorating disorders associated with obesity (1996) Clin Ther, 18, pp. 1006-1035Masheb, R.M., Grilo, C.M., Weight loss expectations in patients with binge-eating disorder (2002) Obes Res, 10, pp. 309-314Cowburn, G., Hillsdon, M., Hankey, C.R., Obesity management by life-style strategies (1997) Br Med Bull, 53, pp. 389-408Glenny, A.M., O'Meara, S., Melville, A., Sheldon, T.A., Wilson, C., The treatment and prevention of obesity: A systematic review of literature (1997) Int J Obes, 21, pp. 715-737Poston, W.S., Foreyt, J.P., Successful management of the obese patient (2000) Am Fam Physician, 61, pp. 3615-3622Wadden, T.A., Foster, G.D., Behavioral treatment of obesity (2000) Med Clin North Am, 84, pp. 441-461Garrow, J.S., Summerbell, C.D., Meta-analysis: Effect of exercise, with or without dieting, on the body composition of overweight subjects (1995) Eur J Clin Nutr, 49, pp. 1-10Miller, W.C., Koceja, D.M., Hamilton, E.J., A meta-analysis of the past 25 years of weight loss research using diet, exercise, or diet plus exercise intervention (1997) Int J Obes, 21, pp. 941-947Poston, W.S.C., Haddock, C.K., Dill, P.L., Thayer, B., Foreyt, J.P., Lifestyle treatments in randomized clinical trials of pharmacotherapies for obesity (2001) Obes Res, 9, pp. 552-563Ayyad, C., Andersen, T., Long-term efficacy of dietary treatment of obesity: A systematic review of studies published between 1931 and 1999 (2000) Obes Rev, 1 (2), pp. 113-119Rivlin, R.S., Therapy of obesity with hormones (1975) N Engl J Med, 292, pp. 26-29Bashin, S., Wallace, W., Lawrence, J.B., Lesch, M., Sudden death associated with thyroid hormone abuse (1981) Am J Med, 71, pp. 887-890Smith, H.J., Roche, A.H.G., Jagusch, M.F., Herdson, P.B., Cardiomyopathy associated with amphetamine administration (1976) Am Heart J, 91, pp. 792-797Weintraub, M., Long-term weight control study: Conclusions (1992) Clin Pharmacol Ther, 51, pp. 642-646Abenhaim, L., Moride, Y., Brenot, F., Appetite-suppressant drugs and the risk of primary pulmonary hypertension (1996) N Eng J Med, 335, pp. 609-616Mark, E.J., Patalas, E.D., Chang, H.T., Evans, R.J., Kessler, S.C., Fatal pulmonary hypertension associated with short-term use of fenfluramine and phentermine (1997) N Eng J Med, 337, pp. 602-606Connoly, H.M., Xrary, J.L., McGoon, M.D., Hensrud, D.D., Edwards, B.S., Edwards, W.D., Schaff, H.V., Valvular heart disease associated with fenfluramine-phentermine (1997) N Eng J Med, 337, pp. 581-588Weissman, N.J., Tighe Jr, J.F., Gottdiener, J.S., Gwynne, J.T., An assessment of heart-valve abnormalities in obese in obese patients taking dexfenfluramine, sustained-release dexfenfluramine, or placebo N Eng J Med, 339, pp. 713-718Weissman, N.J., Panza, J.A., Tighe Jr, J.F., Gwynne, J.T., Natural history of valvular regurgitation 1 year after discontinuation of dexfenfluramine therapy. A randomized, double blind, controlled trial (2001) Ann Intern Med, 134, pp. 267-273Kerman, W.N., Viscidly, C.M., Brass, L.M., Phenylpropanolamine and the risk of hemorrhagic stroke (2000) N Eng J Med, 343, pp. 1826-1832Weigle, D.S., Pharmacological therapy of obesity: Past, present, and the future (2003) J Clin Endocrinol Metab, 88, pp. 2462-2469Schuh, L.M., Schuster, C.R., Hopper, J.A., Mendel, C.M., Abuse liability assessment of sibutramine, a novel weight control agent (2000) Psychopharmacology, 147, pp. 339-346James, W.P.T., Astrup, A., Finer, N., Hilsted, J., Kopelman, P., Rossner, S., Saris, W.H.M., Van Gaal, L.F., Effect of sibutramine on weight maintenance after weight loss: A randomized trial (2000) Lancet, 356, pp. 2119-2125Hazenberg, B.P., Randomized, double-blind, placebo-controlled, multicenter study of sibutramine in obese hypertensive patients (2000) Cardiology, 94, pp. 152-158Tambascia, M.A., Geloneze, B., Repetto, E.M., Geloneze, S.R., Picolo, M., Magro, D.O., Sibutramine enhances insulin sensitivity ameliorating metabolic parameters in a double blind placebo controlled trial (2003) Diab Obes Metab, , in pressGuerciolini, R., Radu-Rdulescu, L., Boldrin, M., Dallas, J., Moore, R., Comparative evaluation of fecal fat excretion induced by orlistat and chitosan (2001) Obes Res, 9, pp. 364-367Rossner, S., Sjostrom, L., Noack, R., Meinders, E., Noseda, G., Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity (2000) Obes Res, 8, pp. 49-61Finer, N., James, W.P.T., Kopelman, P.G., Lean, M.E.J., Willians, G., One-year treatment of obesity: A randomized, double-blind, placebo-controlled, multicentre study of orlistat, a gastrointestinal lipase inhibitor (2000) Int J Obes, 24, pp. 306-313Lindgarde, F., The effect of orlistat on body weight and coronary heart disease risk profile in obese patients: The Swedish Multimorbidity Study (2000) J Intern Med, 248, pp. 245-254Karhunen, L., Franssila-Kallunki, A., Rissanen, P., Valve, R., Klehmainen, M., Rissanen, A., Uusitupa, M., Effect of orlistat treatment on body composition and resting energy expenditure during a two-year weight-reduction program in obese Finns (2000) Int J Obes, 24, pp. 1567-1572Hill, J.O., Hauptman, J., Anderson, J.W., Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: A 1-year study (1999) Am J Clin Nutr, 69, pp. 1108-1116Heymesfield, S.G., Segal, K.R., Hauptman, J., Effects of weight loss with orlistat on glucose tolerance and progression to type 2 diabetes in obese adults (2000) Arch Intern Med, 160, pp. 1321-1326Halpern, A., Mancini, M.C., Suplicy, H., Zanella, M.T., Repetto, G., Gross, J., Jadzinsky, M., Matos, A.G., Latin-American trial of orlistat for weight loss and improvement in glycaemic profile in obese diabetic patients (2003) Diab Obes Metab, 5, pp. 180-188Wadden, T.A., Berkowitz, R.I., Womble, L.G., Sarwer, D.B., Arnold, M.E., Steinberg, C.M., Effects of sibutramine plus orlistat in obese women following 1 year of treatment by sibutramine alone: A placebo-controlled trial (2000) Obes Res, 8, pp. 431-437Van Gaal, L.F., Rissanen, A., Scheen, A.J., Ziegler, O., Rössner, S., Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study (2005) Lancet, 365, pp. 1389-1397. , for the RioEurope Study GroupPi-Sunyer, F.X., Aronne, L.J., Heshmati, H.M., Devin, J., Rosenstock, J., Effect of Rimonabant, a Cannabinoid-1 Receptor Blocker, on Weight and Cardiometabolic Risk Factorsin Overweight or Obese Patients. RIO-North America: A Randomized Controlled Trial (2006) JAMA, 295, pp. 761-775Després, J.P., Golay, A., Sjöström, L., Effects of Rimonabant on metabolic risk factors in overweight patients with dyslipidemia (2005) N Engl J Med, 353, pp. 2121-2134. , for the Rimonabant in Obesity-Lipids Study groupScheen AJ, Finer N, Hollander P, Jensen MD, Van Gaal LFRIO-Diabetes Study Group. Efficacy and tolerability of rimonabant in overweight or obese patients with type 2 diabetes: a randomised controlled study. Lancet 200611:368:1660-72. Erratum in: Lancet 2006.11;368:1650Allison, D.B., Mentore, J.L., Heo, M., Antipsychotic-induced weight gain: A comprehensive research synthesis (1999) Am J Psychiatry, 156, pp. 1686-1696Masand, P.S., Weight gain associated with psychotropic drugs (2000) Exp Opin Pharmacother, 1, pp. 377-389Michelson, D., Amsterdam, J.D., Quitkin, F.M., Reimherr, F.W., Rosenbaum, J.F., Zajecka, J., Sundell, K.L., Beasley Jr., C.M., Changes in weight during a 1-year trial of fluoxetine (1999) Am J Psychiatry, 156, pp. 1170-1176Gadde, K.M., Parker, C.B., Maner, L.G., Wagner II, H.R., Logue, E.J., Drezner, M.K., Krishnan, R.R., Bupropion for weight loss: An investigation of efficacy and tolerability in overweight and obese women (2001) Obes Res, 9, pp. 544-551Bray, G.A., Hollander, P., Klein, S., Kushner, R., Levy, B., Fitchet, M., Perry, B.H., A 6-month randomized, placebo-controlled, dose ranging trial of topiramate for weight loss in obesity (2003) Obes Res, 11, pp. 722-733Korner, J., Lo, J., Freda, P.U., Wardlaw, S.L., Treatment with cabergoline is associated with weight loss in patients with hyperprolactinemia (2003) Obes Res, 11, pp. 311-312Cincotta, A.H., Meier, A.H., Bromocriptine (Ergoset) reduces body weight and improves glucose tolerance in obese subjects (1996) Diabetes Care, 19, pp. 667-670Nam, S.Y., Kim, K.R., Cha, B.S., Song, Y.D., Lim, S.K., Lee, H.C., Huh, K.B., Low-dose growth hormone treatment combined with restriction decreases insulin resistance by reducing fat and increasing muscle mass in obese type 2 diabetic patients (2001) Int J Obes, 25, pp. 1101-1107Toubro, S., Astrup, A., Breum, L., Quaade, F., Safety and efficacy of long-term treatment with ephedrine, caffeine and an ephedrine/caffeine mixture (1993) Int J Obes, 17 (SUPPL. 1), pp. S73-S78Brolin, R.E., (1996) Update: NIH consensus conference. Gastrointestinal surgery for severe obesity. Nutrition, 12, pp. 403-404Capella, R.F., Capella, J.F., Vertical banded gastroplasty-gastric bypass: Preliminary report (1991) Obes Surg, 1, pp. 389-393Scopinaro, N., Ginaetta, E., Adami, G.F., Biliopancreatic diversion for obesity at eighteen years (1996) Surgery, 119, pp. 261-268Evans, J.D., Scott, M.H., Intragastric balloon in the treatment of patients with morbid obesity (2001) Br J Surg, 88, pp. 1245-1248Cigaina, V., Gastric pacing as therapy for morbid obesity: Preliminary results (2002) Obes Surg, 12 (SUPPL. 1), pp. 12S-16SChanoine JP, Hampl S, Jensen C, Boldrin M, Hauptman J. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA 2005 15293(23):2873-83Godoy-Matos A et al. Treatment of obese adolescents with sibutramine: A Randomized, double, Controlled Study. The Journal of Clinical Endocrinology and Metabolism200590(3):1460-1465Xanthakos, A.S., Daniels, S.R., Inge, T.H., Bariatric Surgery in adolescents: An update (2006) Adolesc Med Clin, 17 (3), pp. 589-612Inge, T.H., Krebs, N.F., Garcia, V.F., Skelton, J.A., Guice, K.S., Strauss, R.S., Bariatric Surgery for severily overweight adolescents: Concerns and recommendations (2004) Pediatrics, 114 (1), pp. 217-223. , Review