Body fat distribution is now recognized as an important predictor of the adverse health consequences of obesity. Upper body obesity, especially with increasing visceral fat, is associated with hypertension, insulin resistance, dyslipidemia, type II diabetes mellitus and premature coronary death. Several lines of evidence suggest that abnormal adipose tissue lipolysis, resulting in elevated free fatty acid (FFA) availability, may contribute to some of the metabolic consequences of upper body obesity. The vast majority of the elevated systemic FFA release appears to come from upper body, non-splanchnic adipose tissue. Thus, dysregulation of upper body, non-splanchnic adipose tissue lipolysis may play an important role in contributing to health consequences of fat distribution.