Obesity, a burgeoning worldwide health system challenge, is associated with several comorbidities, including non-alcoholic fatty liver disease (NAFLD), diabetes, atherosclerosis, and osteoarthritis, leading to serious problems to people's health. Adenosine is a critical extracellular signaling molecule that has essential functions in regulating most organ systems by binding to four G-protein-coupled adenosine receptors, denoted A 1 , A 2A , A 2B , and A 3 . Among the receptors, a growing body evidence highlights the key roles of the adenosine 2A receptor (A 2A R) in obesity and related diseases. In the current review, we summarize the effects of A 2A R in obesity and obesity-associated non-alcoholic fatty liver disease, diabetes, atherosclerosis, and osteoarthritis, to clarify the complicated impacts of A 2A R on obesity and related diseases.