The objective of this study was to investigate whether an increase in total adiposity, without a concomitant increase in intrahepatic triglyceride (IHTG) content is associated with metabolic complications. For that purpose, 10 subjects with class I obesity [body mass index (BMI) 30.0-34.9 kg/m≥] were matched with 10 subjects with class III obesity (BMI ≥40 kg/m2) on the basis of age, sex, and IHTG content. The analysis revealed that despite considerable differences in BMI, body fat mass (measured by dual-energy x-ray absorptiometry) and intra-abdominal (visceral) adipose tissue mass (measured at L4-L5 by magnetic resonance imaging) there were no signficant differences in liver, skeletal muscle, and adipose tissue insulin sensitivity or VLDL metabolism between groups matched on IHTG content. These results suggest that the increase in metabolic dysfunction associated with an increase in whole-body adiposity and BMI does not occur without a concomitant increase in liver fat.