Background Obesity is a risk factor for metabolic syndrome, which is a combination of metabolic abnormalities leading to development of cardiovascular abnormalities. Based on factors such as body mass index and metabolic syndrome, specific phenotypes for obesity have been established. These include metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), metabolically unhealthy obese (MUO), and metabolically healthy non-obese (MHNO). Echocardiography is a standard, noninvasive modality that is widely used to assess cardiovascular function. A systematic review and meta-analysis of echocardiographic studies in adult obesity found that obese adults were 4.2 times more likely to have left ventricular hypertrophy than nonobese adults.This study was conducted with the aim of the echocardiographic assessment of cardiac function in various obesity phenotypes. Material and methods This observational study was done in a tertiary care hospital and conducted for a period of two years from August 2019 to August 2021. Anthropometric data was obtained and metabolic parameters were estimated. After obtaining institutional ethical clearance, 400 patients were categorized into four groups of 100 based on their obesity phenotypes: MUO, MHO, MUNO, and 100 age- and sex-matched non-obese metabolically healthy individuals (MHNO) as controls. Echocardiographic assessment such as systolic and diastolic dysfunction was studied among above mentioned obesity phenotypes. The data was analysed using appropriate statistical significance tests. Results The mean BMI was highest in the MUO group (30.07 ±2.53), followed by MHO (28.79±2.3), and lowest in the MHNO group (22.77±1.13). The proportion of patients with Grade II diastolic dysfunction was higher in MUO patients (43%) compared to MHO patients (12%) and MUNO patients (16%). In contrast, the proportion of patients with Grade I diastolic dysfunction was lower in MUO patients (46%) compared to MHO patients (55%) and MUNO patients (57%). Systolic dysfunction in metabolically healthy non-obese (MHNO) patients (57.97 ± 2.34) was significantly higher than in MHO patients (51.83 ± 4.66, p <
0.0001), MUNO patients (51.49 ± 4.64, p <
0.0001), and MUO patients (49.9 ± 3.65, p <
0.0001). The proportion of patients with Grade II diastolic dysfunction was higher in MUO (43%) compared to MHO (12%) and MUNO (16%). In contrast, the proportion of patients with Grade I diastolic dysfunction was lower in MUO (46%) when compared to MHO (55%) and MUNO (57%). Systolic dysfunction in MHNO (57.97±2.34) was significantly higher as compared to MHO (51.83±4.66, p-value<
.0001), MUNO (51.49±4.64, p-value<
0.0001) and MUO (49.9±3.65, p-value<
0.0001). Conclusion Cardiac function abnormalities in various phenotypes exhibit a significant positive correlation, including ventricular systolic and diastolic dysfunctions. Therefore, multidisciplinary management of all obesity phenotypes should be initiated as early as possible to prevent future cardiovascular morbidity and mortality.