The role of adipose-derived exosomes as an important mediator of intercellular communication in the regulation of lipid metabolism has gradually become a hot research topic in recent years. Lipid metabolism is closely related to energy homeostasis and a variety of metabolic diseases (e.g., obesity, diabetes, cardiovascular diseases). Adipose-derived exosomes may play an important role in the maintenance of metabolic homeostasis by regulating adipocyte secretory functions, energy metabolic pathways, and signaling between adipose tissue and other organs. They are particularly critical in the regulation of insulin resistance and adipose deposition and play an important role in the development of metabolic diseases. Although a large number of studies have explored the potential mechanisms of adipose-derived exosomes, their specific roles in different physiological and pathological states are unclear. This paper reviews the research progress of adipose-derived exosomes in adipose metabolic diseases, focusing on their potential mechanisms in adipocyte function, energy metabolism, and metabolic disease development. These studies provide new perspectives and ideas for future basic research and metabolic disease intervention strategies.