The phrase “metabolically healthy obesity” first entered the scientific lexicon in the early 2000s, when some observational data indicated insulin resistance was not a universal or inevitable finding among all persons with obesity.1,2 Analyses from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 illustrated the phenomenon that more than one-third of persons with obesity (as defined by Quételet index [body mass index] ≥30.0 kg/m2) failed to exhibit common clinical manifestations of obesity, including hypertension, dyslipidemia, or insulin resistance, whereas more than 20% of persons of normal body composition (as defined by BMI