OBJECTIVES: This study evaluated the association of patients with a BMI > 27 kg/m2 vs. a BMI °Ý18 and °Ü27 kg/m2 with cardiometabolic risk factors (CMRFs). METHODS: A retrospective review of an Electronic Medical Record database containing ambulatory health record data for a nationally representative sample of over 5 million US citizens with a BMI °Ý18 kg/m2 and °Ý18 years of age was conducted. Patients with a valid BMI were included and stratified by no CMRFs or with one or more diagnoses or prescription orders associated with high triglycerides (TG), low high density lipoprotein (HDL), type 2 diabetes or hypertension two years prior to the last observation date. RESULTS: A total of 499,594 patients were identified in the study where 56% (281,988) had a BMI > 27 with a CMRF distribution of none (49.79%) one (35.36%) two (13.01%), three (1.70%) or four (0.14%). Of those with one risk factor 141,852 (31.29%) had hypertension, 10,866 (2.90%) had diabetes, 3,667 (0.92%) had increased TGs and 1,201 (0.26%) had low HDL. Compared to patients with no risk factors patients with 1-4 risk factors were significantly more likely to be in the > 27 kg/m2 group in all cases (p <0.001). Odds rations were 2.64 for hypertension, 2.21 for elevated triglycerides, 1.91 for diabetes and 1.45 for low HDL; 3.58 for any 2 risk factors, 4.24 for any 3 risk factors and 5.07 for all 4 risk factors, relative to having no CMRFs. CONCLUSION: Patients with CMRFs including hypertension, elevated triglycerides, diabetes or low HDL were anywhere from 5.07 to 1.45 times more likely to be have a BMI > 27. Diagnoses and treatments for CMRFs may be used as surrogate measures for the presence of obesity in claims data. Drugs that decrease both weight and improve CMRFs in such patients could be beneficial.