The endocannabinoid system has been suspected to contribute to the association of visceral fat accumulation with metabolic diseases. We determined whether circulating endocannabinoids are related to visceral adipose tissue mass in lean, subcutaneous obese, and visceral obese subjects (10 men and 10 women in each group). We further measured expression of the cannabinoid type 1 (CB 1 ) receptor and fatty acid amide hydrolase (FAAH) genes in paired samples of subcutaneous and visceral adipose tissue in all 60 subjects. Circulating 2-arachidonoyl glycerol (2-AG) was significantly correlated with body fat (r ؍ 0.45, P ؍ 0.03), visceral fat mass (r ؍ 0.44, P ؍ 0.003), and fasting plasma insulin concentrations (r ؍ 0.41, P ؍ 0.001) but negatively correlated to glucose infusion rate during clamp (r ؍ 0.39, P ؍ 0.009). In visceral adipose tissue, CB 1 mRNA expression was negatively correlated with visceral fat mass (r ؍ 0.32, P ؍ 0.01), fasting insulin (r ؍ 0.48, P < 0.001), and circulating 2-AG (r ؍ 0.5, P < 0.001), whereas FAAH gene expression was negatively correlated with visceral fat mass (r ؍ 0.39, P ؍ 0.01) and circulating 2-AG (r ؍ 0.77, P < 0.001). Our findings suggest that abdominal fat accumulation is a critical correlate of the dysregulation of the peripheral endocannabinoid system in human obesity. Thus, the endocannabinoid system may represent a primary target for the treatment of abdominal obesity and associated metabolic changes. Diabetes 55:3053-3060, 2006 E ndocannabinoids are lipid mediators derived from membrane phospholipids or triglycerides with complex effects on body weight and metabolic regulation (1,2). Several enzymes are involved in the synthesis and degradation of the two most important endocannabinoids, anandamide and 2-arachidonoyl glycerol (2-AG). At least two G-protein-coupled cannabinoid receptors (CB 1 and CB 2 ) have been identified (3,4). Activation of central CB 1 receptors clearly promotes food intake and weight gain (5-7). However, pharmacological blockade with rimonabant (SR141716) or genetic knockout of the CB 1 receptor demonstrated that weight reduction under these conditions is only partly promoted by decreased food intake (8 -10). These findings prompted the search for peripheral metabolic effects of endocannabinoids. CB 1 receptors have now been identified in rodent liver (11), skeletal muscle (12), adipocytes (9,13), and pancreas (14). The potential role of peripheral CB 1 receptors for metabolic regulation is further promoted by statistical analyses of clinical trials, suggesting that the influence of CB 1 receptor blockade on adiponectin levels, lipids, and glucose homeostasis goes beyond the effect of weight loss alone (15-17).In general, endocannabinoid formation and signaling is dependent on external stimuli such as cellular stress, tissue damage, or metabolic challenges (3,4). However, recent findings point to profound changes in the regulation of the endocannabinoid system in obesity. Experimental data suggest that the endocannabinoid sy...