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This review explores the pathophysiology of adiposopathy (\u201csick fat\u201d), where hypertrophic adipose tissue triggers systemic metabolic failure via the adipose\u2013hepatic axis. Impaired subcutaneous adipose tissue (SAT) expandability, ectopic lipid accumulation, chronic inflammation, and maladaptive endocrine signaling are the hallmarks of adiposopathy (\u201csick fat\u201d), a worldwide adipose tissue dysfunction. Through integrated adipose\u2013organ communication networks, these changes support systemic cardiometabolic illness, MASLD, and hepatic insulin resistance. 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