There is an emerging epidemic of non-communicable diseases like obesity, hyperlipidemia, heart disease, diabetes, stroke and cancers. Till recently these diseases were believed to be problem of affluent countries but are now being realized to be affecting developing countries. Many of these illnesses are the result of changes in diet and life-styles that characterize the 'nutritiontransition' which accompanies economic development and the increasing urbanization.

It is estimated that by 2025, India will have more people with diabetes (57 million) than any other country(1) and that prevalence of coronary heart disease has increased by a factor of six to eight(2). Indians as an ethnic group are also more prone to abdominal obesity which is a major concern. Increase in visceral fat leads to a state of Insulin resistance (impairment of insulin action) which in turn leads to a deadly Metabolic Syndrome (also known as Syndrome X, a combination of glucose intolerance, hyperinsulinemia, central obesity, hypertension and dyslipidemia)(3).

In this regard one area that needs attention is a common perception that- "Metabolic disease is only a problem of urban rich who can easily pay for their treatment". Undoubtedly the epidemic is currently more common in the urban rich. However, obesity and metabolic diseases affect the urban poor as well as the rich of Asia. That 20 to 60% of households in this region have both undernourished child and overweight adults is indicative of the need to address these issues also as problems of poverty and not exclusively of wealth (4). In a recent study from low socioeconomic stratum residing in urban slums of New Delhi, cardiovascular risks like hypertension and hypertriglyceridemia were noted in a significant number of cases even at BMI and waist circumference (WC) values considered "normal." The data suggested that definitions of "normal" ranges of BMI and WC need to be revised for Asian Indians (5).

Pediatricians have a very important role to play in the control of these epidemics with the accumulating evidence that most of these diseases have their origin in childhood, and particularly linked to obesity . Historically, a fat child meant a healthy child, and the concept of "bigger is better" was widely accepted by pediatricians and caretakers. In recent years, however, this perception has drastically changed as it is learnt that obesity in childhood causes a wide range of serious complications and increases the risk of premature illness and death later in life (6,7). In view of its rapid development in genetically stable populations, there is general agreement among experts that the environment, rather than biology, is driving this epidemic (8). Fundamental changes in the social environment and family life-styles will be needed to combat this emerging public-health crisis.