This chapter discusses the role of neuroanatomy in the development and maintenance of obesity. Similar to other addictive behaviors, alterations in dopaminergic and opioid pathways involved in food reward are important in obesity. The reward system, including the striatal nucleus accumbens, caudate nucleus, amygdala, anterior insula, and OFC, has been implicated in the development of obesity. Activation in these areas to food cues predicts food consumption, weight gain, and changes with weight loss. Interestingly, gut hormones can modulate the activation of these reward systems both at rest and in response to food stimuli. Surgical interventions for obesity have proven to be the most effective tool for treating obesity. However, if anatomical manipulations of the gut can alter the hedonic evaluation of food, then the gut-brain axis may be the most important target for future treatments of obesity. This chapter provides a comprehensive overview of the neuroanatomical basis of obesity and highlights the importance of understanding the reward system in the development and treatment of obesity.