For Caucasian women, an excess of abdominal fat is a potent risk factor for the development of diabetes and cardiovascular disease. However, there is limited information regarding the health risks of upper body obesity for African-American women despite a higher prevalence of obesity and obesity-related diseases and a reportedly higher prevalence of abdominal fat accumulation. This study aimed to determine whether UBO, independent of total body fatness, is as potent a diabetic and CVD risk factor for black women as has been confirmed for white women. Diabetes and CVD risks and androgenic status were assessed in nondiabetic, premenopausal women of similar body fatness who differed by race (black or white) and body fat distribution (UBO or lower body obesity). In black women, high-density lipoprotein cholesterol was the only measurement adversely affected by abdominal fat; HDL cholesterol was significantly lower in the black UBO group (1.14 ± 0.05 mM) compared with the black LBO group (1.37 ± 0.08 mM). This contrasts markedly with our findings in white women. In confirmation of previous reports, white UBO women, compared with white LBO counterparts, had significantly higher glucose (967.6 vs. 709.2 mM/2 h) and insulin (120.5 vs. 52.1 pM/2 h) areas and significantly lower peripheral insulin sensitivities (0.99 vs. 2.95 × 10−4) min−1/µU/ml). In addition, HDL cholesterol levels were significantly lower in the white UBO group (1.03 mM) compared with the white LBO group (1.49 mM), whereas plasma TG levels (white UBO, 1.72 vs. white LBO, 0.88 mM) and dBPs (white UBO, 84 vs. white LBO, 75 mmHg) were significantly higher.Finally, in the white UBO group compared with the white LBO group, SHBG levels were significantly lower (27.5 vs. 51.6 nM), whereas the free testosterone levels were higher (2.21 vs. 1.49%). We conclude that an equivalent degree of UBO, independent of total body fatness, is less detrimental for black women than for white women with regard to the risks of developing diabetes and CVD.