A 20-year cohort study reported that metabolically healthy obesity (MHO) is still associated with substantial cardiovascular risk over time. The findings shift the narrative from “metabolically healthy” as a protective label to a risk state that requires long-term monitoring. The study evaluated MHO as a phenotype characterized by obesity without typical metabolic derangements and followed participants through long-term outcomes. Researchers reported that cardiovascular event risk remains meaningfully elevated compared with metabolically healthy non-obese groups. Clinically, the results reinforce the need for longitudinal risk stratification rather than relying on a single time-point metabolic assessment for long-term decision-making in obesity care pathways.