The alarming and still increasing prevalence of obesity and associated cardiovascular risk raises much concern. The increase in cardiovascular risk depends to a significant extent on the changes in lipid profiles as observed in obesity. These changes are decreased high-density lipoprotein cholesterol and increased triglyceride levels. Much effort has already been expended into the elucidation of the mechanisms behind these obesity-associated lipid changes. Insulin resistance certainly plays a central role and, in addition, both hormonal and neurologic pathways have recently been found to play an important role. This article focuses on the mechanisms involved in the development of the proatherogenic lipid changes associated with obesity.