<p>Obesity remains the most common risk factor for cardiovascular disease in Western nations. While considerable effort has focused on identifying risk factors, which contribute to the increase incidence of complications and disease, an emerging concept is the existence of resilience factors, which mitigate disease. An important resilience factor gaining increased appreciation is the amount of skeletal muscle mass. In this review, we will explore how obesity increases the most-identified vascular component of metabolic vascular disease – endothelial dysfunction—how increases in muscle mass may protect vascular function in the obese population. This review advances the concept the obesity is less a disease of body mass than body composition which is reflected in the degree of negative vascular outcomes and may be of increased relevance in consideration of therapies that promote loss of muscle mass while reducing overall body size.</p>