IntroductionThe risk of kidney stones in metabolically healthy obesity (MHO) individuals is largely unexplored. This study using percent body fat (%BF) to categorize obesity, to investigate the association between MHO as well as other metabolic syndrome-obesity combined phenotypes and kidney stones in a national representative population.Materials and methodsThis cross-sectional study included 4,287 participants in the National Health and Nutrition Examination Survey from 2011 to 2018. Metabolically healthy status was defined as not having any component of metabolic syndrome or insulin resistance. Obesity was identified by %BF, which was measured and assessed by dual-energy x-ray absorptiometry (DXA) scan. Participants were cross-classified by metabolic health and obesity status. The outcome was self-report kidney stones. Multivariable logistic regression model was used to examine the association between MHO and kidney stones.ResultsA total of 358 participants had kidney stones [weighted prevalence (SE): 8.61% (0.56%)]. The weighted prevalence (SE) of kidney stones in MHN, MHOW, and MHO groups was 3.13% (1.10%), 4.97% (1.36%), and 8.55% (2.09%), respectively. After adjusting for age, sex, race and ethnicity, education level, smoking status, alcohol consumption, physical activity, daily water intake, CKD stage 3–5, and hyperuricemia, MHO individuals (OR: 2.90, 95% CI: 1.18, 7.0) had a significantly higher risk of kidney stones than those with metabolically healthy normal weight. In metabolically healthy participants, a 5% increment in %BF was associated with a significantly higher risk of kidney stones (OR: 1.60, 95% CI: 1.20, 2.14). Furthermore, a nonlinear dose–response relationship between %BF and the kidney stones was observed in metabolically healthy participants (Pfor non-linearity = 0.046).ConclusionUsing %BF to define obesity, MHO phenotype was significantly associated with higher risks of kidney stones, suggesting that obesity can independently contribute to kidney stones in the absence of metabolic abnormalities and insulin resistance. Regarding kidney stones prevention, MHO individuals might still benefit from lifestyle interventions aimed at healthy body composition maintenance.