The purpose of the study was to determine the prevalence of metabolic syndrome as a cluster of risk factors for atherosclerotic cardiovascular disease and type 2 diabetes mellitus and its individual components in groups of men and women with primary obesity having different types of fat distribution. The study involved 142 men and 185 women with primary alimentary-constitutional obesity. The study participants were divided into 2 groups depending on waist-to-hip ratio value. Standardized criteria were used to determine the prevalence of metabolic syndrome and its individual components among the examined men and women. The ratios of the number of participants with lower or upper type of fat distribution in men and women were 28:114 and 84:101, respectively. Hence the frequency of lower type of fat distribution was 19.7% in men and 45.4% in women (p < 0.000). Men with lower type of body fat distribution as compared to upper type were characterized by a lower prevalence of abdominal obesity (1.9 times), hypertriglyceridemia (1.4 times), low HDL-C (1.6 times), and hypertension (2 times). The frequency of metabolic syndrome in men with lower type of fat distribution was lower by 2.7 times than that of men with upper type of fat distribution. Women with lower type of fat distribution as compared to upper type had a lower prevalence of abdominal obesity (1.2 times), hypertriglyceridemia (1.8 times), low HDL-C (1.2-fold), and hypertension (in 1.5 times). The frequency of metabolic syndrome in women with lower type of fat distribution was lower by 1.9 times than that of women with upper type of fat distribution. Both men and women in the groups with lower type of fat distribution were missing such a component of metabolic syndrome as hyperglycemia i.e. they had the minimal risk of type 2 diabetes mellitus.