The article reviews the evolving understanding of adipose tissue dysfunction in obesity, diabetes, and vascular diseases. It highlights that adipose tissue, traditionally viewed as a storage depot for fatty acids, now is recognized as an active endocrine organ with significant roles in lipid and glucose metabolism, producing hormones and cytokines such as TNF-α, IL-6, adiponectin, leptin, and PAI-1. The increased prevalence of visceral obesity and related cardiovascular risk factors is closely linked to the rising incidence of cardiovascular diseases and type 2 diabetes. The paper discusses the physiological roles of adipocytes and adipose tissue, the endocrine functions of adipocytes, and the differences between visceral and subcutaneous adipose tissue. It also explores the transcription factors involved in adipocyte development and metabolism, and the mechanisms by which adipose tissue dysfunction leads to insulin resistance, type 2 diabetes, and atherosclerotic vascular diseases. The article concludes by emphasizing the importance of weight reduction and increased physical activity in improving adipose tissue function and reducing the risk of metabolic and vascular diseases.The article reviews the evolving understanding of adipose tissue dysfunction in obesity, diabetes, and vascular diseases. It highlights that adipose tissue, traditionally viewed as a storage depot for fatty acids, now is recognized as an active endocrine organ with significant roles in lipid and glucose metabolism, producing hormones and cytokines such as TNF-α, IL-6, adiponectin, leptin, and PAI-1. The increased prevalence of visceral obesity and related cardiovascular risk factors is closely linked to the rising incidence of cardiovascular diseases and type 2 diabetes. The paper discusses the physiological roles of adipocytes and adipose tissue, the endocrine functions of adipocytes, and the differences between visceral and subcutaneous adipose tissue. It also explores the transcription factors involved in adipocyte development and metabolism, and the mechanisms by which adipose tissue dysfunction leads to insulin resistance, type 2 diabetes, and atherosclerotic vascular diseases. The article concludes by emphasizing the importance of weight reduction and increased physical activity in improving adipose tissue function and reducing the risk of metabolic and vascular diseases.