The epidemic of obesity and overweight poses a major challenge to the prevention of chronic noncommunicable diseases throughout the world. In some developing countries it presents a double burden alongside enduring problems of undernutrition. Current IOTF estimates suggest that at least 1.1 billion adults are overweight including 312 million who are obese. The prevalence of obesity has doubled or even risen threefold in less than two decades, while in children this is rising at an even faster rate in some regions of Europe to levels of up to 36% in parts of Italy and elsewhere.The comparative burden of disease due to raised body mass index is among the top five leading risk factors in both developed and low mortality developing countries. When viewed in conjunction with the burden of raised cholesterol and hypertension, these components of the metabolic syndrome form the major cause of mortality and disease in Europe and are guaranteed to increase with the rising trend in overweight and obesity while amplifying the burden of cardiovascular disease. The increase in childhood obesity will, unchecked, accentuate the rise in early adult type 2 diabetes and cardiovascular disease. CONCLUSIONS: A fundamental policy shift is required to widen responsibility for the prevention of diet, activity and weight-related ill health across the whole of Europe’s population. Only such a comprehensive approach offers any realistic prospect of averting a public health catastrophe for Europe and indeed for the whole world.