Cardio-metabolic diseases (CMDs) such as obesity, type 2 diabetes (T2D) and hypertension are now highly prevalent throughout low- and middle-income countries, even though half of the T2D cases cannot be explained by obesity. Non-obese T2D individuals may have been exposed to foetal programming and/or be genetically susceptible to abdominal obesity. There is evidence for ethnic-specific risks for cardiometabolic disease. This calls for expanding research collaboration with so-called South partners in order to qualify decision making on diagnosis and prevention of CMDs at global level.