Obesity is now being recognised as a neurological disease that is associated with serious morbidity and increased mortality. Understanding gastro intestinal signalling to the subcortical areas of the brain offer a view on a therapeutic window for obesity which promises better clinical benefits as well as lower side effects.

Bariatric surgery is a good model to investigate gut brain signalling in humans and rodents, because it provides major changes in appetite with subsequent weight loss maintenance. Following gastric bypass, pleiotrophic responses from the gastro intestinal tract may contribute to improved appetite reduction, long-term lowering of body weight, glycaemic control and improvements in end organ damage.

The new third-generation medications based on optimising gut brain signalling are however now facilitating a revolution. These medications appear to address many of the diseases leading to obesity at their origins. Treating obesity as a chronic disease with effective therapies allows the disease to come under control and remain under control as long as the therapies continue. The impact of effectively treating obesity will reduce the symptoms of obesity such as excessive appetitive behaviour, but it will also reduce the complications of obesity which will have far-reaching benefits for the individual, healthcare systems, and wider society.