eng Oriental Scientific Publishing Company Biosciences Biotechnology Research Asia 0973-1245 2025-03-25 22 1 37 53 10.13005/bbra/3339 54093 article Neil Birenkumar Panchal 1 Vipul Manusinh Vaghela 2 Department of Pharmacy Gujarat Technological University, Nr. Vishwakarma Government Engineering College, Nr. Visat Three Roads, Visat - Gandhinagar Highway, Chandkheda, Ahmedabad –- Gujarat , India A. R. college of pharmacy & G. H. Patel institute of pharmacy, Vallabh Vidyanagar, Anand, Gujarat, India. Obesity represents a significant global health challenge with multifactorial origins and escalating prevalence. This review examines three fundamental pathophysiological mechanisms: adipose tissue dysfunction characterized by inflammatory mediator release and metabolic perturbations, gut microbiota alterations affecting metabolic signaling and energy homeostasis, and adipose tissue hypoxia leading to cellular stress and metabolic disruption. Current pharmacological interventions demonstrate variable efficacy and comprehensive safety profiles: orlistat through lipase inhibition with gastrointestinal considerations, phentermine/topiramate via appetite suppression with monitoring requirements, and liraglutide through GLP-1 receptor agonism with established metabolic benefits, with specific focus on their limitations and long-term outcomes. MC4R has emerged as a promising therapeutic target, highlighting advances in targeted drug development for obesity management. Surgical innovations, particularly laparoscopic sleeve gastrectomy and endoscopic sleeve gastroplasty, demonstrate substantial and sustainable weight loss with improved metabolic health outcomes compared to traditional procedures, emphasizing their role in severe obesity treatment. The integration of digital health technologies - mobile applications, wearable devices, and telemedicine platforms - facilitates lifestyle modifications and enhances treatment adherence through continuous monitoring and patient engagement, revolutionizing long-term management approaches. Genetic and hormonal influences significantly impact treatment response, emphasizing the necessity for individualized therapeutic approaches. This comprehensive analysis provides an integrated framework for understanding obesity's complex pathophysiology and treatment modalities, establishing a foundation for effective, personalized intervention strategies in clinical practice. https://www.biotech-asia.org/vol22no1/advancements-in-obesity-unravelling-pathophysiology-treatment-strategies-and-innovative-approaches/ Adipose dysfunction;  Digital health; Innovative treatments; Obesity pathophysiology; Obesity pharmacotherapy