According to WHO obesity is defined as an excessive and improper accumulation of fat tissue in human body which puts health in jeopardy. The most widely accepted quantitative cut-off is a body mass index (BMI) value ≥30 kg/m2. Beyond the influence on acquisition and quality of echocardiographic images it is related to structural remodeling and functional impairment of cardiac function. To the most common belong concentric hypertrophy of left ventricular muscle, diastolic dysfunction, left atrial dilatation and hypertrophy of right ventricular wall. Recent studies reported also a deterioration of left ventricular and right ventricular systolic function detected mainly with tissue Doppler and strain analysis. To the typical findings in obese patients belong thickened layer of epicardial adipose tissue (EAT) recognized as a predictor of atherosclerosis progression and cardiovascular events.