OBJECTIVE: Healthy obese phenotype with favorable metabolic profiles is proposed. However, whether healthy obesity leads to target organ changes is controversial. We investigated the impact of a healthy obesity on cardiovascular structure and function. METHODS: A total of 2540 participants without known cardiovascular disease were enrolled. According to BMI and the metabolic syndrome (MetS) component, the participants were divided into six groups: healthy (none of five MetS components) normal weight (BMI <23 kg/m), unhealthy (one or more of five MetS components) normal weight, healthy overweight (BMI 23-24.9 kg/m), unhealthy overweight, healthy obesity (BMI ≥25 kg/m), and unhealthy obesity. The cardiovascular changes were assessed by echocardiography, tissue Doppler imaging (TDI), carotid ultrasonography, and pulse wave velocity (PWV). RESULTS: In a multivariate analysis after adjusting for age, sex, heart rate, high-sensitivity C-reactive protein, and medication for hypertension and diabetes mellitus, the unhealthy overweight and obese groups showed statistically significant changes in the left ventricular mass index, mitral E/A ratio, E/Ea ratio, TDI Ea velocity, common carotid artery intima-media thickness (CCA-IMT), and brachial-ankle PWV (P < 0.001), compared with the healthy normal weight individuals. In the healthy overweight and obese groups, CCA-IMT and brachial-ankle PWV values were similar, but left-ventricular mass index and TDI Ea velocity were significantly different (P < 0.001). CONCLUSION: Healthy obesity was associated with subtle changes in left ventricular structure and function. These data provide evidence that metabolically healthy phenotypes with excess weight may not be a benign condition.