Bone marrow adipose tissue (BMAT) is an important modulator of metabolic and skeletal homeostasis in obesity. This review summarises current evidence supporting mechanistic links between BMAT and the development and progression of obesity. Accumulating data indicate that, beyond serving as a distinct adipose depot, BMAT functions as a dynamic and adaptive regulator within the bone marrow (BM) microenvironment under obese conditions. Therefore, limiting BM adipogenesis, regulating BMAT-derived adipokines, reversing metabolic dysfunction, and modulating systemic energy homeostasis have been proposed as potential therapeutic strategies for obesity. Collectively, BMAT is a previously underappreciated yet promising target for tailored, mechanism-based therapeutic strategies in obesity. Future research should prioritise mechanistic dissection and clinical validation of BMAT-targeted strategies, together with improved imaging and quantitative methodologies and Traditional Chinese Medicine (TCM)-informed system-level regulatory approaches, to facilitate their translation into effective therapies for obesity and related metabolic disorders.
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