In review provides data on pathophysiological relationships of intestinal microbiota with body weight regulation in patients with abdominal obesity. In manuscript discusses the leading mechanisms by which the gut microbiota can contribute to obesity and metabolic diseases, analyzes its components, including gastrointestinal peptides, short-chain fatty acids, bile acids, farnesoid receptors, etc. Western diet high in salt, dysbiosis and endotoxemia can be powerful pro-inflammatory factors responsible for the development of insulin resistance and weight gain. It is promising to prescribe agonists of gastrointestinal peptides, probiotics and prebiotics, which in abdominal obesity are able to inhibit dysbiosis, regulate immune functions, and protect the organism from low-intensity chronic inflammation.