Advances in the management of obesity: non-pharmacological strategies, herbal formulations, current pharmacotherapy, emerging drugs, and future perspectives

Obesity is a long-term, complex disorder characterised by excessive adiposity that increases the risk of metabolic and cardiovascular diseases. Obesity is a significant health problem, with its prevalence increasing steadily over the last several decades. This rising trend has contributed substantially to the burden of metabolic, cardiovascular and other chronic diseases. Lifestyle modification remains the primary approach to obesity treatment; long-term weight reduction is difficult to achieve and sustain due to complex neurohormonal mechanisms that regulate appetite and energy homeostasis. Consequently, pharmacotherapy has become an essential component of comprehensive obesity management in appropriately selected patients. Recent advances in obesity pharmacology have revolutionised treatment strategies, particularly with the introduction of incretin-based therapies such as glucagon-like peptide-1 (GLP-1) receptor agonists and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists, which have demonstrated unprecedented efficacy in achieving clinically meaningful and sustained weight loss. Furthermore, several novel agents, including triple agonists, oral peptide formulations, and combination therapies, are currently undergoing clinical evaluation and are expected to further transform obesity treatment. This review provides the current understanding of obesity pharmacotherapy, discusses approved anti-obesity medications, highlights emerging therapeutic agents and drugs under clinical development, and explores future perspectives in obesity management. Additionally, the review addresses current challenges, safety concerns, and public health strategies required to combat the growing obesity epidemic.