In the global epidemic of diabetes and obesity, Asia is being hit the hardest. Each year, 17 million people die from stroke and heart disease worldwide. Of these deaths, 11 million will occur in developing regions, including Asia. Approximately 1000 million people worldwide are overweight; over 388 million people are expected to die from a chronic disease in the next 10 years, mainly cardiovascular diseases. The majority of these people are expected to come from Asia – the most populous region of the planet. The projected costs in both human and financial terms are staggering: it has been estimated that over the next 10 years China alone will lose 558 billion USD as a result of premature deaths from heart disease, stroke and diabetes. Juliana Chan describes the current status and future impact of the metabolic syndrome and diabetes in Asia.