Currently available anti-obesity drugs sibutramine and orlistat, and the soon to be available rimonabant, all produce similar degrees of clinically meaningful weight loss and weight loss maintenance, even though they differ considerably in their mode of action. Pharmacologically induced weight toss has a beneficial impact on a number of metabolic and cardiovascular risk factors, such as glucose homeostasis, blood pressure, central adiposity, and dyslipidaemia. In some cases, these effects appear to be over and above that explained by weight loss. These effects are important if obese patients are to be treated not just for their weight but also to reduce coexisting metabolic and cardiovascular risk factors.