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Rationale: The study  on  specifics of metabolic phenotypes of obesity in children and adolescents seems be highly relevant for a comprehensive assessment  of causal and  pathophysiological  roles of obesity in the  atherogenesis. Aim: To identify particulars of metabolic  phenotypes of obesity in the  population of the  school children in the  city of Arkhangelsk. Materials and methods: We examined 102 patients aged from 10 to 15 years with obesity, abdominal type (boys, 44.6%, girls, 55.4%). According to the results of a comprehensive clinical and laboratory assessments, the patients  were divided  into  the  group  of metabolically  healthy obese   (children  and  adolescents  with  obesity, but without any metabolic abnormalities) and the group of metabolically unhealthy obese (having at least 1 metabolic abnormality). The list of metabolic abnormalities  included  high triglyceride levels, low levels of high density lipoprotein  cholesterol (HDL-C), high blood pressure, impaired fasting glucose, increased  C-reactive protein  levels. Results: The  group  comparison   showed  that  the  mean levels  of  all studied   parameters  of  pro-atherogenic  metabolic  abnormalities  were significantly higher  in the  patients  with  metabolically  active obesity (the mean triglyceride levels in the groups of metabolically active and metabolically healthy obesity were 1.31 vs 0.74 mmol/L, glucose levels, 4.92  vs 4.54  mmol/L,  C-reactive protein,  3.15  vs 2.30 mg/mL, systolic and diastolic blood pressure, 118.97 vs 110.23 mmHg and 72.90 vs 68.58 mmHg, respectively; p < 0.001), with the  exclusion of the   mean level of anti-atherogenic HDL-C, which was lower (1.27 vs 1.49 mmol/L; p < 0.001). Also, in addition to abdominal obesity, 21.43% of school children with metabolically active obesity had ≥ 2 atherogenic factors, as well as some pro-inflammatory abnormalities (C-reactive protein levels were higher in one third of children and adolescents of this group, with a borderline  significance level). Sixty percent  of children and adolescents with obesity and metabolic abnormalities had abnormal lipid parameters. Pro-atherogenic metabolic abnormalities  were  found  in all children  and  adolescents with increased C-reactive protein levels. Conclusion:  Distinctly different  phenotypes  of obesity with various degrees  of metabolic  abnormalities were  found  in the  pediatric  population. Formation of combination of atherogenic clinical and metabolic abnormalities  (dyslipidemia, impaired glucose  tolerance,  high blood  pressure)  is possible already in children and adolescents with metabolically active obesity. They can be associated with chronic inflammation, and as such could be the first stage of development of atherosclerosis, metabolic  syndrome  and  cardiovascular  disease.