The role of sibutramine as an effective adjunct to diet and exercise in weight management programmes has been proven in clinical trials. Although the reality of managing obesity in clinical practice is very different from that of a controlled clinical trial, there is good evidence that sibutramine is an easy-to-use and highly effective additional therapy when used in everyday practice to manage obesity and its complications. It is possible to predict which patients will respond well to sibutramine treatment, and to modify programmes and support to ensure the best outcome for patients, whatever their clinical circumstances.