Obesity is a potent risk factor for metabolic and cardiovascular disease at the population level. At the individual patient level, however, correlations between body mass index and cardiovascular disease are not always straightforward due, in part, to differences among adipose tissue depots with respect to the overall rate of adipocyte dysfunction, tissue vascularization, and local degree of inflammation. Adipose tissue develops in several distinct anatomical depots within the body, and the differential expansion of these depots is of great importance. Expansion of visceral or abdominal white adipose tissue (WAT) has been most strongly correlated to insulin resistance and cardiovascular disease in humans and animals. Several studies have documented that peripheral adiposity (especially leg fat) may protect against cardiovascular risk.