Adipose tissue is not only required for energy storage but is an essential endocrine organ with a central role in the pathology of obesity. The understanding of its role, both in human and equine medicine, is continually evolving. With obesity being an ever-growing problem in the equine population, gaining owner compliance is critical when implementing management plans. The aim of this review is to encourage the inclusion of the concept of adiposity in discussions with horse owners on obesity and metabolic syndrome. In doing this, we hope to improve clients understanding and therefore maximise the impact of diagnostic tests, monitoring tools and management.