A constant abundance of food and a sedentary lifestyle had led to an increasing prevalence of obesity in developed and also in developing countries. Obesity and in particular abdominal obesity, is a strong risk factor for the development of type 2 diabetes, hypertension and atherogenic dyslipidaemia and is an independent risk factor for cardiovascular morbidity and mortality. Mounting evedince highlights the role of adipose tissue in the development of a systemic subclinical inflamation that contributes to obesity associated vasculopathy and cardiovascular risk. This has resulted in a serious public health problems. It is critically important to focus our public health efforts on the prevention and our clinical efforts on the treatment of these disesase states. Managing obesity by lifestyle changes alone has met with only limited success. When attempts at lifestyle intervention are inadequate, so pharmacological intervention is often necessary to help patients reduce and maintenance weight loss and change their cardiometabolic risk profile. Blockade of the endocannabinoid system with rimonabant appears to be a promising new strategy in management (abdominal) obesity. The future wil focus on the interaction between the central nervous system and the peripheral tissue, mainly gut and modulators of thermogenesis.