To identify the characteristics of individuals transitioning from metabolically healthy obesity (MHO) to unhealthy obesity and the factors influencing the change.
This is a nationwide cohort study using data from the National Health Insurance Service in South Korea.
Individuals with obesity but metabolically healthy in 2009 and 2010 and those still obese 4 years later were selected.
Sociodemographic, physical, metabolic, and health behavior variables were collected, and logistic regression was used to find an association with the transition.
We analyzed 1,564,467 individuals, observing significant differences in all variables and the transition from MHO to unhealthy obesity. Among males, the transition was associated with smoking and drinking positively and physical activity negatively. Among females, drinking demonstrated a negative correlation. Regardless of age, regular exercise was negatively associated with the transition for all individuals. Except for older adults, all age groups showed a positive correlation with smoking and drinking.
Considering the significant factors in the transition, it is essential to develop and implement interventions varied by gender and age to delay and prevent the change in metabolic status. The necessity of developing interventions enables individuals to engage in regular exercise, regardless of age and gender.

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