Over recent decades, there has been a worldwide increase in the number of people with obesity – currently around 300 million according to the International Obesity Task Force – and there are no signs of a slow-down. Furthermore, rates of overweight and obesity in adults and children are rising dramatically in developing countries. A large and growing body of evidence points to the transformation of lifestyles worldwide – over-consumption of energy-dense food and decreased physical activity – as the driving force behind this pandemic. For the last three decades, Pakistan has been experiencing such a transformation. Fatema Jawad describes the range of factors that make young people in Pakistan, from the very wealthy to the most underprivileged, increasingly vulnerable to the dangers of obesity-related complications, including type 2 diabetes.