The concept of metabolically healthy obesity (MHO) – where obesity is not accompanied by cardiometabolic abnormalities such as impaired glucose tolerance – is subject to some controversy. In particular, there is debate regarding whether MHO is benign in the sense that risks of cardiovascular disease (CVD) and metabolic conditions such as diabetes mellitus (DM) are not elevated despite obesity. A number of recent studies suggest, however, that MHO conveys an intermediate risk for cardiometabolic disease, that is, lower than that for metabolically unhealthy obesity (MUHO) but higher than that for metabolically healthy normal weight (MHN). In the current issue of Menopause, Hsu et al present consistent results regarding incidence of DM in analyses of data from postmenopausal women, an understudied group, in the Women’s Health Initiative.