The epidemic of obesity, metabolic syndrome, and type 2 diabetes is skyrocketing. Together with these conditions, nonalcoholic fatty liver disease is also increasing at an alarming state, with its prevalence reaching 34% of the U.S. adult population. This review paper focuses on the prevalence and diagnosis of fatty liver as well as on its causes and metabolic consequences. Similar to adipose tissue, extra lipids in insulin-sensitive tissues such as the liver may have critical secretory functions. In addition, as adipokines, “hepatokines” could be an interesting new research avenue.