Aim: The gut–brain axis (GBA) plays a crucial role in maintaining systemic homeostasis through bidirectional communication between the central nervous system and the gastrointestinal tract. This review aims to summarize current evidence regarding the impact of obesity on GBA function and to discuss potential therapeutic strategies targeting this pathway. Material and methods: A narrative literature review was conducted using scientific publications indexed in databases including PubMed, ScienceDirect, and the European Journal of Endocrinology. Studies addressing obesity-related alterations in neural signaling, gut microbiota composition, and peptide hormone regulation (e.g., cholecystokinin, peptide YY, ghrelin) were analyzed. Particular attention was given to mechanisms involving dopaminergic reward circuits and emerging therapeutic targets such as ghrelin antagonists, gamma-aminobutyric acid modulators, and melanocortin-4 receptor agonists. Results: Evidence indicates that obesity is associated with significant alterations in gut microbiota composition, vagal signaling, and neuroendocrine regulation of appetite and reward pathways. These changes contribute to dysregulation of nutrient absorption, inflammatory responses, and metabolic homeostasis. Both invasive and non-invasive interventions—including dietary modification, microbiome-targeted therapies, pharmacological agents, and neurostimulation techniques—show potential to modulate GBA signaling and restore physiological balance. Conclusions: Understanding the complex relationship between obesity and the gut–brain axis may provide novel therapeutic targets for improving metabolic regulation and reducing obesity-related complications. Further clinical and translational studies are required to confirm the long-term effectiveness of GBA-oriented interventions.