There is a constellation of metabolic abnormalities which includes centrally distributed obesity, decreased levels of HDL cholesterol, elevated triglycerides, high blood pressure, and high blood glucose (hyperglycaemia). This is known as the metabolic syndrome. Associated with a five-fold risk for type 2 diabetes and two- to three-fold increase in risk for cardiovascular disease, the metabolic syndrome is now considered one of the principal public health issues of the 21st century. The premature ill-health and deaths resulting from cardiovascular diseases and diabetes are set to cripple the health budgets of many nations – both developed and developing. Paul Zimmet and George Alberti call for a global consensus to overcome the worldwide public health challenge presented by the metabolic syndrome.