Background:Obesity is a major risk factor for cardiovascular diseases (CVDs), but the risk varies among different obesity phenotypes. Understanding the relationship between obesity phenotypes, endothelial function, and subclinical cardiovascular risk markers is crucial for effectively managing and preventing CVD. This study aims to evaluate endothelial function and subclinical cardiovascular risk markers in various obesity phenotypes among patients in a tertiary care hospital in Central India. Materials and Methods:A cross-sectional study was conducted on 180 participants in the Department of Medicine in a tertiary care teaching rural hospital of Wardha district in Central India from March 2022 to June 2023. Participants included outpatients, inpatients, and staff members who met specific inclusion and exclusion criteria. Anthropometric measurements, clinical assessments, and endothelial function were evaluated using flow-mediated dilation (FMD). Data were analyzed using Chi-square tests and ANOVA to determine the significance of differences among groups. Results:The study population was divided into four groups: metabolically healthy obesity (MHO), metabolically unhealthy obesity (MUO), metabolically unhealthy normal weight, and control. The groups found significant differences in age, weight, body mass index (BMI), waist circumference, waist–hip ratio, blood pressure, fasting blood glucose, high-density lipoprotein cholesterol, triglycerides, and high-sensitivity C-reactive protein levels. The MUO group exhibited the highest cardiovascular risk markers, with mean fasting blood glucose of 151.37 mg/dL and mean systolic blood pressure of 137.00 mm Hg. The MHO group showed better endothelial function, with an average FMD of 7.2% compared to 5.6% in the MUO group. Conclusions:Metabolically unhealthy individuals, regardless of BMI, have higher cardiovascular risks, underscoring the need for early intervention and lifestyle modifications. Further, longitudinal studies are needed to establish causal relationships and develop targeted strategies for preventing CVDs in obese populations.