Lipids (characterized as oils, greases, fats and long-chain fatty acids) are important organic components of wastewater. Their amount, for example, in municipal wastewater is approximately 30-40% of the total chemical oxygen demand. The concern over the behavior of lipids in biological treatment systems has led to many studies, which have evaluated their removal, but still the exact behavior of lipids in these processes is not well understood. In this review, we discuss the current knowledge of how lipids/fatty acids affect both aerobic and anaerobic processes and specific methods that have been used in an attempt to enhance their removal from wastewater. Overall, the literature shows that lipids/fatty acids are readily removed by biological treatment methods, inhibitory to microbial growth as well as the cause of foaming, growth of filamentous bacteria and floc flotation.