The Metabolic syndrome (MetS), obesity and type 2 diabetes are growing global epidemics especially in Asian populations. In light of the differences in body build between people from the West and the East, definitions of obesity in Asians have been modified accordingly. Data from Hong Kong, an epitome of future China, may provide important insight into the potential interactions between nature and nurture in this global epidemic. Now supported by large scale studies, it is clear that Chinese type 2 diabetic patients exhibit marked phenotypic heterogeneity in terms of risk profiles and complications. Apart from genetic differences, age- and stress-related neurohormonal dysregulation may also contribute to the increasing prevalence of obesity, type 2 diabetes and MetS in Chinese living in modern societies. In this mini-review, we aim to summarise findings from our group collected during the last decade in our attempt to understand this epidemic and to develop evidence-based care models to reduce the impact of this health hazard.