Nonalcoholic fatty liver disease (NAFLD) and its severe form, nonalcoholic steatohepatitis (NASH), are linked to cirrhosis, hepatocellular carcinoma, cardiovascular disease, and type 2 diabetes. Lifestyle changes are essential, but pharmacological treatments for obesity and type 2 diabetes are crucial for NASH management. Current treatments include pioglitazone, GLP-1 receptor agonists, and SGLT2 inhibitors. Pioglitazone, a thiazolidinedione, improves insulin sensitivity and reduces liver fat, with evidence of NASH resolution in clinical trials. GLP-1 receptor agonists improve glycemic control, weight loss, and reduce cardiovascular risk, with some showing NASH resolution. SGLT2 inhibitors reduce liver fat and offer cardiorenal protection. Obesity treatments like GLP-1 agonists and other drugs also benefit NAFLD. New drugs in development, such as lanifibranor, resmetirom, and tirzepatide, show promise for NASH. These treatments are important for managing NAFLD and NASH, especially in patients with type 2 diabetes, to prevent cirrhosis, diabetes progression, and cardiovascular disease. Physicians should consider these therapies based on guidelines and individual patient needs.Nonalcoholic fatty liver disease (NAFLD) and its severe form, nonalcoholic steatohepatitis (NASH), are linked to cirrhosis, hepatocellular carcinoma, cardiovascular disease, and type 2 diabetes. Lifestyle changes are essential, but pharmacological treatments for obesity and type 2 diabetes are crucial for NASH management. Current treatments include pioglitazone, GLP-1 receptor agonists, and SGLT2 inhibitors. Pioglitazone, a thiazolidinedione, improves insulin sensitivity and reduces liver fat, with evidence of NASH resolution in clinical trials. GLP-1 receptor agonists improve glycemic control, weight loss, and reduce cardiovascular risk, with some showing NASH resolution. SGLT2 inhibitors reduce liver fat and offer cardiorenal protection. Obesity treatments like GLP-1 agonists and other drugs also benefit NAFLD. New drugs in development, such as lanifibranor, resmetirom, and tirzepatide, show promise for NASH. These treatments are important for managing NAFLD and NASH, especially in patients with type 2 diabetes, to prevent cirrhosis, diabetes progression, and cardiovascular disease. Physicians should consider these therapies based on guidelines and individual patient needs.