Increased oxidative stress and abundance of reactive oxygen species (ROS) are positively correlated with a variety of pathophysiologies, including cardiovascular disease, type 2 diabetes, Alzheimer's disease, and neuroinflammation. In adipose biology, diabetic obesity is correlated with increased ROS in an ageand depot-specific manner and is mechanistically linked to mitochondrial dysfunction, endoplasmic reticulum (ER) stress, potentiated lipolysis, and insulin resistance. The cellular quality control systems that homeostatically regulate oxidative stress in the lean state are down-regulated in obesity as a consequence of inflammatory cytokine pressure leading to the accumulation of oxidized biomolecules. New findings have linked protein, DNA, and lipid oxidation at the biochemical level, and the structures and potential functions of protein adducts such as carbonylation that accumulate in stressed cells have been characterized. The sum total of such regulation and biochemical changes results in alteration of cellular metabolism and function in the obese state relative to the lean state and underlies metabolic disease progression. In this review, we discuss the molecular mechanisms and events underlying these processes and their implications for human health and disease. Adipose oxidative stress is a major contributor to insulin resistance and cellular dysfunction (1) and is regulated in an ageand depot-specific manner. Adipose oxidative stress increases with age in both humans and experimental mice and varies between depots. For example, in contrast to younger mice (6 months), aged C57BL/6 mice (23 months) exhibit increased ROS 2 in the visceral adipose depot (epididymal) as compared with the subcutaneous depot (inguinal) (2). Similar experiments on human tissue have revealed that subcutaneous adipose tissue from obese diabetic subjects exhibit increased H 2 O 2 production compared with that from age-matched obese, nondiabetic subjects or to lean controls (3). Moreover, ROS levels are higher in epicardial fat as compared with subcutaneous adipose tissue (4). Furthermore, oxidized lipids and proteins accumulate to a greater extent in visceral depots compared with subcutaneous depots (5, 6). These observations point out the complexity of linking oxidative stress to disease and the molecular mechanisms that drive dysfunction and dysregulation. Major challenges exist in defining the specifics of reactive oxygen species-driven pathology and its connectivity to human health and disease.