The regional distribution of body fat has been repeatedly found to be a significant and independent risk factor for cardiovascular disease in both obese men and women. To determine whether abnormalities in lipid/lipoprotein profile and systolic and diastolic blood pressure are related to specific fat depots early in the course of obesity, we used magnetic resonance imaging to measure accurately intra-abdominal and subcutaneous fat mass in 14 obese (Body mass index (BMI) 30±1.3) and ten non-obese (BMI 21±0.5) adolescent girls matched for age and Tanner stage development. Intra-abdominal and subcutaneous fat depots were 2-3 fold greater in obese than non-obese girls (p<0.01). Total cholesterol, triglyoerides (TG), LDL cholesterol(LDL-C), basal insulin and systolic and diastolic blood pressure were significantly higher in obese girls than controls. Of note, in obese girls, intra-abdominal fat, but not BMI or waist-to-hip ratio, was highly correlated with basal insulin (r=0.55, p<0.04), triglycerides (r=0.53, p>0.03) and HDL-cholesterol (r=-0.54, p<0.04). Femoral adipose tissue was inversely related to triglyceride (r=-0.51) and LDL cholesterol (R=-0.56, p<0.05) levels in obese girls. The study indicates that early in the natural history of obese adolescent girls cardiovascular risk factors are related to the amount of intra-abdominal fat.