The disorder now known as the "metabolic syndrome "was first recognized 50 years ago, but the use of various definitions led to confusion over its real nature. The metabolic syndrome is directly linked to android obesity, which reflects insulin resistance; it lies at the root of all associated risk factors and is a forerunner of type 2 diabetes. Screening is based on systematic waist measurement, taking ethnic origin into account. This pragmatic approach avoids the uncertainties generated by different definitions and is less restrictive than a simple diagnosis of the metabolic syndrome. Non drug treatment of android obesity is inexpensive and effective but may be difficult to apply, owing to a number of social issues.