Endocrinologists have unique skills in evaluating and caring for patients with metabolic diseases. As such, they have a special role to play within the organizations in which they work as leaders in the approach to managing obese patients. Recent epidemiological data demonstrate that the prevalence of obesity is beginning to plateau. However, the rate of severe obesity in adults and the prevalence of overweight among children continue to grow, suggesting that in the future there will be an increasing burden of obesity-related illnesses. A number of recent studies have identified a number of novel mechanisms that predispose to obesity including several newly identified genes, the role of intestinal microflora, and even social networks. The selection of treatment for obese patients remains a complex issue. Recent studies demonstrate that a range of dietary approaches including the Atkins diet can provide modest weight loss, although the key feature appears to be adherence in the dietary strategy. High levels of physical activity appear to be necessary to maintain a reduced state, although modest increases in activity improve fitness. Although the new understanding of biology of weight regulation has provided a wide range of potential drug targets, available pharmacotherapy options remain limited although a number of potential targets show promise. Recent data provides the most enthusiasm for surgical treatment of obesity. Several recent studies demonstrate a reduction in mortality and dramatic benefits in diabetes in obese patients treated surgically. Questions remain as to the best surgical approach and the cost effectiveness. Research advances in obesity continue to move at a rapid pace and raise hopes for more effective management strategies in the future.