Hypoxia-inducible factor prolyl 4-hydroxylases (HIF-P4Hs, also known as PHDs or EglNs) are enzymes that act as cellular oxygen sensors. Inhibition of HIF-P4Hs leads to stabilization of hypoxiainducible transcription factors (HIFs) which initiate a gene expression program that allows to cope with low oxygen levels and to restore tissue oxygenation. This involves for example upregulation of erythropoiesis and angiogenesis, modulation of inflammatory responses and reprogramming of metabolism. Currently, several pharmacological HIF-P4H inhibitors are in clinical trials mainly for renal anemia. However, recent data suggest that HIF-P4H inhibitors could also be considered to treat metabolic disorders. Here we will discuss the potential of targeting HIF-P4Hs and the HIF pathway for the treatment of obesity, metabolic syndrome, atherosclerosis and fatty liver diseases. Highlights Inhibition of HIF-P4Hs, which act as molecular oxygen sensors, is the so far best understood mechanism to regulate the oxygen sensing pathway. Several HIF-P4H inhibitors are currently in phase 3 randomized clinical trials for treatment of renal anemia with no reported serious side effects until now. Recent data from preclinical, clinical and epidemiological studies support that besides anemia activation of the hypoxia response via HIF-P4H inhibition is a powerful tool to regulate metabolism and may be beneficial for conditions such as obesity, metabolic syndrome, T2D, NAFLD/NASH or liver fibrosis.