Obesity is associated with an increased risk of premature death as individuals with obesity typically develop type 2 diabetes (T2D), dyslipidemia, fatty liver disease, hypertension and cardiovascular disease (CVD). However a subgroup of obese patients seem to be protected against metabolic complications. The aim of the review is to summarize current knowledge on the so-called “healthy obesity” with a focus on the paediatric population. There are several data showing that certain obese adolescents do not experience metabolic complications. On the other hand, other clinical longitudinal studies suggest that metabolically healthy obesity (MHO) is a dynamic concept that should be taken into account over time. However, there is an agreement that some obese adolescents should be monitored more closely for adverse events, while others may not be at a high risk. Therefore, whether MHO in youngsters is a questionable entity remains a matter of debate.