Summary: Overweight and obesity is a problem that affects around 18 million Poles and is a major challenge for the healthcare system. Excess body weight is the cause of more than 200 complications that significantly reduce the quality and length of life. However, effective treatment of overweight and obesity leads to remission of complications and improved prognosis for patients. The cornerstone of disease management is always behavioral therapy based on proper nutrition and physical activity. Recent years have seen the rapid development of new pharmacological treatments for obesity, which should be considered in any patient with a body mass index (BMI) of 30 kg/m2 or 27 kg/m2 if there is at least one obesity-related complication. Complications and comorbidities of obesity are key to drug selection. However, such a strategy does not take into account the mechanisms that lead to the development of excess body weight, which may be an important cause of treatment failure in obesity- -related diseases. In patients with elements of the metabolic syndrome, drugs from the incretin receptor agonist group are recommended: glucagon-like peptide-1 (GLP-1) receptor analogues and the dual agonist of GLP-1 and glucose-dependent insulinotropic peptide (GIP) receptors, tirzepatide. However, many patients with metabolic syndrome suffer from emotional eating, and in this situation the treatment of choice is the combination of naltrexone with bupropion, which is also used to treat patients with obesity and depressed mood or those who want to stop smoking. So, are incretin receptor agonists an option for every obese patient? Both clinical recommendations and clinical practice suggest that they are not. Patients for whom incretin agonists cause unacceptable side effects, or for whom their effect wanes after initial satisfactory results, and who regain weight after stopping treatment, should be considered for alternative therapy with naltrexone with bupropion. A diagnosis of emotional eating should also be considered, as well as the depressed mood of patients for whom naltrexone with bupropion is the drug of choice.