The currently available drugs for treatment of obesity act on two pharmacologic systems in the central nervous system: the noradrenergic system and the serotonergic system. There are clear and convincing clinical data that these drugs are effective and safe. However, several types of barriers exist to their proper and effective use, including public perceptions that obesity is a disease resulting from lack of willpower, professional expectations that anorexiant drugs should cure obesity, hindrance by state licensing agencies, regulatory rigidity, limited research funding, and legislative inaction. In spite of these limitations, several new and potentially valuable drugs are under development, and given an appropriate clinical and therapeutic environment, the future is bright for treatment of obesity.