The rapid increase in the prevalence of obesity and the rise in eating disorders require a revision of treatment approaches. Modern clinical practice supplements the therapeutic arsenal of lifestyle modification and diet therapy with next-generation medicinal products, inevitably raising issues of pharmacotherapy safety, long-term risks, and nutritional support for physicians. The interview discusses fundamental changes in diet and the role of ultraprocessed foods as a risk factor for metabolic catastrophes. The possibilities and limitations of nutrigenomics are examined, in particular in the context of polymorphisms in folate metabolism genes. Special attention is given to the safety of glucagon-like peptide-1 (GLP-1) receptor agonists: the risks of gastroparesis, sarcopenia, and micronutrient deficiency are analyzed. The paradox of sibutramine use in Russian and international clinical practice is discussed. The conversation concludes with the problem of the absence of targeted drugs for anorexia nervosa and the prospects for modulation of cannabinoid and ghrelin receptors. The treatment of nutrition-related diseases requires an interdisciplinary approach, in which pharmacological intervention is necessarily accompanied by strict nutritional control and assessment of individual genetic risks.