Obesity surgery is not a scalable solution for obesity and diabetes. Options for pharmacotherapy are sorely required because there will be patients who cannot and will not have surgery, or perhaps will require a bridge to surgery. Although oral agents such as Orlistat and Bupropion/Naltrexone are marketed in Europe, these treatments suffer from considerable side effects that limit their appeal and efficacy. Gut hormone treatments, exemplified by high-dose Liraglutide (Saxenda) and Semaglutide, are now coming into the market. These take advantage of physiological satiety and metabolic pathways. However, even high-dose Liraglutide has limited efficacy and there is a significant percentage of patients who do not respond. This presentation will look at the concept of multiple/combination gut hormones as practicable treatments for diabetes and obesity.