Treatment of non-alcoholic fatty liver disease involves not only the management of the liver disease itself but the associated metabolic risk factors as well. However, no single treatment has been shown to be universally efficacious. Effective treatment regimens directed at both decreasing insulin resistance as well as the processes of necroinflammation have been investigated and include lifestyle intervention, surgical treatment, and pharmacotherapy. Lifestyle modification, weight loss, and physical activity represent the cornerstone of treatment. Given the important role of insulin resistance in the pathophysiology of non-alcoholic steatohepatitis, thiazolidinediones are used to improve insulin resistance. Ongoing large multicenter studies will provide information about long-term efficacy and safety of pioglitazone in patients with non-alcoholic steatohepatitis. Many other medications have shown promising results in the investigations using animal models and in preliminary pilot studies. Because the sample sizes of these studies were relatively small and the durations were short, further validation is required.