The modern possibilities of dietary, drug, and bariatric treatment of obesity were analyzed. Attention was drawn to the lack of effective and safe methods of its treatment at present. Although the hereditary genesis of obesity has been proven, genetic engineering has not yet been developed; the future in treatment of obesity belongs in nutrigenomics. The main mechanisms of the pathogenesis of obesity and their correction are presented - insulin resistance, hormonal dysfunction of adipose tissue, and dysregulation of appetite. It is necessary to search for new methods of treatment of obesity to reduce insulin resistance, normalize the secretion of adipokines, increase thermogenesis and create physiological anorectics. Also it is necessary to create drugs that cause apoptosis of fat cells and thereby reduce the number of adipocytes.