Obesity epidemic is becoming a global health problem due to the alarming rise in its rate. Arabs are among the highest countries in obesity prevalence rates in children and adolescents. Abdominal obesity predisposes to metabolic syndrome in the form of hypertension, dyslipidemia, impaired fasting blood sugar ending up by type 2 diabetes, cardiovascular disease, and non- alcoholic fatty liver disease. Screening for obesity co-morbidities is of utmost importance even in the absence of symptoms. Healthy lifestyle in the form of proper nutrition and regular exercise are of great importance. Pharmacotherapy is an emerging and growing line of treatment in obese adolescents. The choice of medication varies according to the cause and co-existing complications. It is indicated after failure of intense lifestyle modification for six months.