Background: Obesity plays a central role in the Metabolic Syndrome (MS), which is defined as a clustering of cardio-metabolic risk factors, including central obesity, abnormalities in glucose metabolism, hypertension and dyslipidaemia; so, with the increasing of obesity we also witnessed the increase of MS cases. As well as in adults, even in children has been described the metabolically healthy obese that identify all obese subjects without metabolic disorders. Objective: The objective of this study was to evaluate one or more parameters able to distinguish obese children metabolically healthy and those potentially at risk of metabolic and cardio-vascular complications. Methods: We evaluated anthropometric and metabolic parameters in 125 overweight and obese children and adolescents (64 M and 61 F) aged 10-16 years (mean age 12.09) with Body Mass Index>85th percentile. According IDF consensus, we divided our children in three groups: obese with metabolic syndrome (MS), obese with alteration of one metabolic parameter (Metabolic Unhealthy obese or MUO) and obese metabolically healthy (MHO). We performed a statistical analysis by a "post hoc" Fisher's LSD analysis, in order to highlight significant differences between means and Standard Deviations of the parameters analyzed among the three groups. Results: 15 children (12%), were diagnosed as suffering from Metabolic Syndrome; 45 (36%) could be considered metabolically unhealthy obese and 65 children (52%) could be considered metabolically healthy obese. systolic blood pressure, diastolic blood pressure and tryglicerides values was statistically significant between all the three groups faced each other.