Obesity remains a leading cause of cardiovascular (CV) events and diabetes worldwide. Although there are at least two main body-size phenotypes (metabolically healthy and metabolically non-healthy) of individuals with established obesity, the cardio metabolic risk amongst these patients’ populations extremely distinguishes. The editorial is discussed the controversies regarding obese paradox and the probabilities to stratify the patients with established obesity in cardio metabolic risk. It is suggested that the biomarkers could predict CV events in patients depending on obese phenotypes. The role of metabolic biomarkers, progenitor cells, natriuretic peptides, inflammatory cytokines and galectin-3 are discussed.