The metabolic syndrome is a constellation of vascular disease risk factors that includes hyperglycaemia, hypertension, and dyslipidaemia, which are largely mediated by accumulating fat depots, particularly when centrally deposited. Increasing adiposity promotes insulin resistance, low grade inflammation and endothelial dysfunction, which promote the development of atherogenic vascular disease. Increases in percentage body fat result from a number of parameters, including ageing, and changes in lifestyle factors that promote a metabolic imbalance, such as decreasing physical activity and adverse dietary patterns. As Asian populations continue to modernize, levels of physical activity are declining as home and workplace jobs become more automated and sedentary and transportation more readily available. Similarly, dietary changes are introduced, with healthy traditional plant-based diets being replaced by cheaper calorie dense high fat foods. These changes are resulting in rapid increases in the prevalence of obesity throughout Asia, and the subsequent development of the metabolic syndrome. To minimise further development of the obesity pandemic and subsequent vascular disease, innovative population-based preventative lifestyle and therapeutic strategies interventions need to be introduced.