Nso-Roca AP, Cortés Castell E, Carratalá Marco F, et al. - This observational, retrospective, cohort study was undertaken to determine if Homeostasis Model Assessment (HOMA) above a set threshold could be the marker of metabolically unhealthy obesity (MUO) in children, or a parameter that can be used in the overall assessment. In the diagnosis of MUO, it is intended to compare the International Diabetes Federation criteria to HOMA. This investigation involved children with obesity and analyzed their metabolic state by means of blood testing and dual-energy X-ray absorptiometry. In total, 96 patients were involved, 44.8% boys and 55.2% girls, ages 6–17 years. The patients with MHO according to the HOMA criterion were younger, had a lower BMI z score, waist–height index, hip–height index, blood glucose, insulin, and lower percentages of total fat, trunk fat, and android fat than those with MUO. The multivariate analysis in HOMA-classified children showed that the percentage of total fat and gynoid fat distributions, as well as triglyceride levels, could be markers of a healthy or unhealthy metabolic state in children with obesity. The use of HOMA as a single criterion was shown to be an effective and simple detector of adiposity, predicting metabolically healthy obesity in children.