Potential differences in body composition between metabolically healthy obese (MHO) and metabolically abnormal obese (OA) adults were explored with 395 obese adults from the Pennington Center Longitudinal Study (18-68 years). Adults were classified as OA (≥2 risk factors: blood pressure ≥130/85 mmHg; triglycerides ≥150 mg dl(-1); high-density lipoprotein cholesterol: men <40, women <50 mg dl(-1); fasting glucose ≥100 mg dl(-1); waist circumference: ≥102 cm men, women ≥88 cm) or MHO (<2 risk factors). Whole-body bone mineral density and content, percent body fat, fat mass, lean mass and trunk adipose tissue mass were measured with dual-energy X-ray absorptiometry. Visceral (VAT), subcutaneous (SAT) and total abdominal adipose tissue (TAT) were measured with computed tomography. Gender-specific general linear regression models were used to determine differences in body composition between MHO and OA controlling for age, race, smoking status and menopause status. In men, MHO had lower fat mass (kg and %), trunk adipose tissue, VAT, SAT, TAT and lean mass compared with OA. MHO women had lower fat mass (kg), lean mass, trunk adipose tissue, VAT and TAT when compared with OA women. In conclusion, OA and MHO cardiometabolic profiles are characterized by differences in body composition consistent between genders.