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Background: Obesity and its related metabolic complications are increasing globally, yet body mass index (BMI) alone inadequately reflects true adiposity and sex-specific body composition differences. Variations in fat mass, lean body mass, visceral fat, and body fluid compartments across age and sex may better explain cardiometabolic risk. Aims and Objectives: To evaluate sex-wise correlations of body composition parameters across different age groups and to assess the limitations of BMI in reflecting true body composition in adults attending a tertiary care hospital in West Bengal. Materials and Methods: This cross-sectional observational study included 1,602 adults (763 males, 839 females) attending the outpatient department of Jagannath Gupta Institute of Medical Sciences & Hospital, Kolkata. Participants were stratified into four age groups (<30, 31–45, 46–60, and >60 years). Anthropometric parameters and body composition indices—including body fat percentage, lean body mass, visceral fat area, intracellular fluid (ICF), and extracellular fluid (ECF)—were assessed using bioelectrical impedance analysis. Sex-wise comparisons were performed using Welch’s t-test. Correlation and receiver operating characteristic (ROC) analyses were applied. Results: Across all age groups, males demonstrated significantly higher lean body mass, visceral fat area, intracellular and extracellular fluid volumes, whereas females exhibited significantly higher body fat percentage and total body fat mass despite comparable BMI values (p<0.001). Advancing age was associated with increased adiposity and progressive decline in lean body mass and intracellular fluid, consistent with sarcopenic obesity. ROC analysis showed lean body mass and fluid compartments to be superior discriminators of sex compared with BMI. Conclusion: Marked sex- and age-specific differences in body composition exist that are not captured by BMI alone. Direct assessment of body composition provides superior phenotypic and metabolic risk stratification and should be integrated into routine clinical and epidemiological evaluation. Key words: • Body composition, • Obesity, • Sex differences, • Visceral fat, • Sarcopenic obesity