Obesity is an increasing health problem in many countries. Striking differences exist in the magnitude of the impact of different obesities on comorbidities. Individuals with peripheral obesity ('pears') possess fat distributed subcutaneously in gluteofemoral areas and the lower part of the abdomen, and are at little risk of metabolic complications. Conversely, individuals with upper-body obesity ('apples') accumulate fat in subcutaneous and visceral deposits and are more prone to metabolic and cardiovascular problems, particularly when visceral fat deposits are abundant. In this article, whether the different risk factors for obesity of 'apples' and 'pears' are largely related to the heterogeneity of function and responsiveness of the adipocytes from visceral and subcutaneous deposits is questioned. Possible pharmacological approaches to the treatment of obesity and related diseases are also considered.