Strategies are being developed to reduce the incidence of diabetes and other associated chronic diseases, including heart disease and many common cancers. Part of the strategy has been to define at-risk groups, especially those with the metabolic syndrome. Perhaps the most readily useable classification is that of National Cholesterol Education Program Adult Treatment Panel III criteria. The ultimate goal has been to increase exercise and reduce body weight. Diets with different macronutrient profiles have been proposed, all of which appear useful if compliance is maintained but may differ somewhat in the spectrum of benefits they confer. Newer drugs have appeared that also may confer benefit metabolically (peroxisome proliferator-activated receptor agonists) or by central mechanisms (cannabinoid antagonists). The changes will likely have to be metabolic and societal and include not only the food industry but also modes of transportation and urban planning.