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Objectives: This study was performed to compare which is better predict cardiovascular event between Metabolically obese but normal weight (MONW) and Metabolically health but obese (MHO). Subjects and methods: We analyzed the data from total 7,007 Korean subjects (2,843 men and 4,164 women) from population based cross-sectional study and their mean age was 62.0±10.5 years. We defined the highest quartile of HOMA-IR as "metabolically obese (highly insulin resistant)" group and the lowest quartile as "metabolically healthy (very insulin sensitive)" group. Furthermore, subjects with their BMI ≥ 25 kg/m² were defined as "obese" group and 18.5 ≤ BMI < 23 kg/m² was defined as "normal weight" group according to Asian-Pacific region criteria for obesity. Results: Waist circumference, diastolic blood pressure, non HDL cholesterol, total cholesterol/HDL cholesterol ratio of MOH were significantly higher than those of MONW. However, fasting glucose and insulin level was significantly higher in MONW than MOH. Among MOH, prevalences of the metabolic syndrome defined by both NCEP and IDF criteria were significantly higher that of MONW (44.6% vs 35.8% in NCEP, 40.7% vs 17.2% in IDF) whereas prevalences of type 2 diabetes mellitus (T2DM) and impaired fasting glucose (IFG) in MONW were significantly higher than MOH (27.2% vs 7.5% in T2DM, 8.8% vs 3.3% in IFG). Furthermore, estimated 10 year CHD risk using Framingham risk score in MONW was significantly higher than MOH (12.1±11.5 vs. 8.9±7.1). Conclusions: Our study results suggested that highly insulin resistant subjects with normal weight might have higher risk for T2DM and CV event compared with obese, but very insulin sensitive subjects. [ABSTRACT FROM AUTHOR]