In this review paper, Després JP describes obesity not only on the basis of excess body fatness but also on the basis of body fat distribution: the regional location of body fat matters. A distinction is also made between screening tools that have been developed to identify individuals likely to have features of the metabolic syndrome vs. the definition of the metabolic syndrome. A special emphasis is placed on the importance of measuring waist circumference as a vital sign in clinical cardiology. The need to go beyond hyperglycemia in the management of macrovascular risk in type 2 diabetes is considered. Finally, it is proposed that weight loss alone is not the appropriate target in abdominally obese patients at high risk of cardiovascular disease. Rather it is suggested that intra-abdominal (visceral) obesity should be the target to optimally manage the cardiovascular risk profile of high-risk individuals.
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