Ghrelin woas recently de-orphaned as an endogenous ligand of growth hormone secretagogue receptor (GHS-R), and is implicated as a short-term meal initiator and a long-term energy balance regulator. Administration of ghrelin causes increases in food intake and body weight in both rodents and humans. Inhibiting its actions with GHS-R anti-sense oligonucleotides, anti-ghrelin antibodies, and peptide antagonists leads to decreased food intake and weight loss in rodents. Despite the much-publicized promise of providing a novel approach for anti-obesity treatment, limited progress has been made in developing small-molecule GHS-R antagonists and no such compound has been advanced to clinical trials. This review will summarize the recent progress in small-molecule GHS-R antagonists and offer some insight into this area of research based on the experience at Abbott Laboratories.