Obesity is increasing in people of Chinese background whether in China or in other countries. The purpose of this review is to discuss the associations of obesity in men and women of Chinese background with cardio-metabolic risk with specific attention to body fat distribution. Evidence suggests that current BMI and WC targets may actually underestimate the cardio-metabolic risk in Chinese compared to European populations from which they were derived. Through a number of investigations, we and others have identified that Chinese men and women tend to have higher cardio-metabolic risk factors at a given body size than people of European background (from which guidelines are generally derived). Our additional investigations have indicated that Chinese men and women have greater amounts of VAT, but similar amounts of DSAT at a given body fat than Europeans and it may be the higher VAT in Chinese people that is, in part, responsible for the greater cardio-metabolic risk in the Chinese. Further investigation of this topic should prove fruitful in shedding light onto the determinants of body fat accumulation and distribution that may help to inform obesity prevention and treatment strategies.