We know that in both Western and Asian adults in the vulnerable overweight groups with impaired glucose tolerance, modest weight loss with specific changes in diet and physical activity can reduce the likelihood of developing Type 2 diabetes. Marked weight loss in severely obese people with diabetes can also ameliorate the risks from their diabetes perhaps for a decade or more. However, clinical interventions to achieve this require intensive personal supervision, which, as a prevention and management strategy involving millions of children and adults, is difficult to provide. In this article Philip James and Neville Rigby make a call for radical new strategies to combat obesity and diabetes worldwide.