The metabolically healthy obesity (MHO) phenotype is partly influenced by race/ethnicity and genetic factors being relatively more prevalent in some groups compared to others. This review examines current evidence on the prevalence of MHO amongst children, adolescents and adults of different racio-ethnic groups; and explores gene variants and single nucleotide polymorphisms (SNPs) that may confer cardioprotection in some racio-ethnic groups compared to others. Literature search of articles published in English was conducted using PubMed, Medline and Google scholar databases, with search terms related to the prevalence of metabolically healthy obesity as well as genetic variants that decrease or increase the risk of metabolic syndrome (MetS). MHO prevalence differed across racio-ethnic groups and gene variants that confer cardioprotection were higher in some racio-ethnic groups compared to others. Lower prevalence of MHO across all ages was particularly reported in the Middle East, while high prevalence was reported in Africans, Americans and some Asian adult population. Excluding environmental and other risk factors, we observed that Caucasians were carriers of gene variants that confer protection against cardiometabolic diseases, whilst Asians showed high frequency of gene variants that increase susceptibility to MetS. A robust understanding of the role of these gene variants, their frequency distribution and racio-ethnic variations may facilitate conceptualisation of appropriate genome wide association studies (GWAS) to determine significant associations between various genetic factors and observed phenotype or disease. This will guide policy formulation and serve as a useful tool in pharmacogenomics and precision medicine.