Obesity drives an excessive triglycerides accumulation in adipose tissueAdipose tissue, which incites immune cell infiltration, causing fibrosisFibrosisand inflammationInflammation, causing local hypoxiaHypoxiain adipocytesAdipocytes, and ultimately insulin resistanceInsulin resistance. The extracellular matrixExtracellular matrix (ECM) complex network of proteins and proteoglycans that offer a scaffold for cells controlling differentiation, migration, repair, survival, and development, and ECM remodeling is required for healthy adipose tissueAdipose tissue expansion. To understand the molecular mechanism of this process is a challenge in order to prevent or treat metabolic diseasesMetabolic disease. This chapter describes the different ECM components and their function related to adipose tissueAdipose tissue and their contribution to restore or maintain insulin sensitivityInsulin sensitivity and the whole body metabolismMetabolism.