Below we review obesity-related pathways (Sections “3.4.1 Inflammatory pathways: systemic low-grade and neuro-inflammation,” “3.4.2 Hormonal pathways: leptin, adiponectin and ghrelin,” “3.4.3 Oxidative stress”), then cardio-metabolic factors likely triggered by obesity (Section “3.4.4 Cardio-metabolic pathways: blood pressure, lipid, and glucose homeostasis”), and their collective impact on the cerebrovascular health (Section “3.4.5 Cerebrovascular pathways”). This evidence concerns the gene ADIPOQ and obesity due to melanocortin 4 receptor deficiency.