Obesity and its comorbidities, including type 2 diabetes mellitus, cardiovascular disease, heart failure and non-alcoholic liver disease are a major health and economic burden with steadily increasing numbers worldwide. The need for effective pharmacological treatment options is strong, but, until recently, only few drugs have proven sufficient efficacy and safety. This article provides a comprehensive overview of obesity and its comorbidities, with a special focus on organ-specific pathomechanisms. Bariatric surgery as the so far most-effective therapeutic strategy, current pharmacological treatment options and future treatment strategies will be discussed. An increasing knowledge about the gut-brain axis and especially the identification and physiology of incretins unfolds a high number of potential drug candidates with impressive weight-reducing potential. Future multi-modal therapeutic concepts in obesity treatment may surpass the effectivity of bariatric surgery not only with regard to weight loss, but also to associated comorbidities.

肥胖及其合并症，包括 2 型糖尿病、心血管疾病、心力衰竭和非酒精性肝病，是一项重大的健康和经济负担，全世界范围内的人数稳步增加。对有效药物治疗方案的需求非常强烈，但直到最近，只有少数药物被证明具有足够的功效和安全性。本文全面概述了肥胖及其合并症，特别关注器官特异性病理机制。减肥手术作为迄今为止最有效的治疗策略，将讨论当前的药物治疗选择和未来的治疗策略。随着人们对肠-脑轴，特别是肠促胰岛素的鉴定和生理学的了解不断增加，人们发现了大量具有令人印象深刻的减肥潜力的潜在候选药物。未来肥胖治疗的多模式治疗概念可能不仅在减肥方面而且在相关合并症方面超过减肥手术的有效性。