This chapter reviews the incidence of abdominal fat and visceral adipose tissue (VAT) in African-American (AA) adults and children, and examines their relationship to cardiometabolic disease. Racial differences in the amount of abdominal fat and VAT stores have been reported in multiple investigations. Despite a greater prevalence of obesity in AAs, studies have consistently shown lower amounts of metabolically harmful VAT in AAs compared to other races or ethnicities. Since AAs have been shown to have less VAT compared to other races/ethnicities, even when matched for body mass index, it may be expected that cardiovascular and metabolic disease risk would also be lower in AAs. However, there is evidence that this speculation does not hold true. This chapter also provides evidence that AAs have lower VAT thresholds at which cardiometabolic disease risk increases compared to other races, as well as data showing racial differences in hormonal variations related to VAT. © 2014 Elsevier Inc. All rights reserved.