The primary dyslipidemia related to obesity is characterized by increased triglycerides, decreased HDL levels, and abnormal LDL composition. Much work has been done to elucidate the pathogenesis of the dyslipidemia of obesity, which seems to be closely related to insulin resistance in obese individuals; however, more studies in humans are needed to further understand the metabolic mechanisms underlying the changes, and to distinguish between the roles of insulin resistance and body fat in the lipoprotein changes. The dyslipidemia associated with obesity no doubt plays a major role in the development of atherosclerosis and CVD in obese individuals. All of the components of the dyslipidemia, including higher triglycerides, decreased HDL levels, and increased small, dense LDL particles, have been shown to be atherogenic. Weight loss and exercise, even if they do not result in normalization of body weight, can improve this dyslipidemia and thus reduce CVD risk. In addition, obese individuals should be targeted for intense lipid-lowering therapy, when necessary.