Some studies have shown that obese individuals have a lower risk of cardiovascular problems when they are metabolically healthy, but accumulating evidence suggests that the risk still remains high in this group. To address this contentious issue, researchers recently evaluated 6,809 participants of the Multi-Ethnic Study of Atherosclerosis to assess the relationship between obesity and cardiovascular disease and mortality over an average of 12 years. Almost half of the obese individuals who were metabolically normal at baseline developed metabolic syndrome during follow-up. These individuals had increased odds of cardiovascular disease than those with stable metabolically healthy obesity or a healthy normal weight. According to the authors, the findings suggest that metabolically healthy obesity is not a stable or reliable indicator of future risk for cardiovascular disease. Therefore, weight loss and lifestyle management for cardiovascular risk factors should be recommended to all individuals with obesity. The study, published in the Journal of the American College of Cardiology, was partly funded by NHLBI.