Title: Prevalence of Metabolic Syndrome in the Asian Indian obese subpopulation and the prevalence of pre-diabetes and diabetes in that population. Background: Metabolic Syndrome (MS), refers to the cluster of risk factors of obesity, dyslipidemia, hypertension and glucose intolerance, and raises the risk of major cardiovascular events and type-2 diabetes. Obesity and insulin resistance play an important role in its pathophysiology. With the obesity pandemic, the obese population in India is at substantial risk of this cluster (MS). The country needs a plan to save itself from a looming MS crisis. This study was carried out in a major tertiary teaching hospital in Mumbai, India. Aims and Objectives: To determine the prevalence of MS (using the new Indian obesity criteria with ATP-III), pre-diabetes and diabetes in the previously healthy obese Indian population and determine their distribution and association of risk factors, especially with obesity. Methodology: It was a randomized cross sectional observational study carried out over a year in 2012-2013. A sample size of 200 was taken with inclusion criteria being adults 18yrs or older with a BMI>=25kg/m2 and after excluding all previously known cases of IFG, T2DM, hypertension or dyslipidemia. Results: The mean age of the sample size was 43.7yrs and mean BMI 26.7 kg/m2. 23.5% subjects had MS: 20.6% males (out of 131) and 29% females (out of 69). 31.8% of the adults less than 30yrs of age had MS and its prevalence rose progressively with BMI and waist circumference (WC). All MS subjects had a high WC, followed closely by the prevalence of blood pressure and IFG as risk factors. 25% of the sample size had pre-diabetes (FBS=100-125mg/dL) and 6.5% had diabetes (FBS>=126mg/dL); 26% males and 23.2% females, and 7.6% males and 4.3% respectively. 36.36% of adults less than 30yrs of age had a FBS>=100mg/dL. Obesity had a directly proportional relationship with MS, IFG, blood pressure, triglycerides and an inverse one with HDL. It also significantly increased the prevalence of MS and the combination of risk factors for MS (70% vs. 42% in non-MS group, p value<0.01). Conclusion: Obesity is the dominant force behind MS and IFG, and is associated with an increase in the risk factors contributing to MS. Obese Indians are at substantially higher risk of CHD and T2DM. With its growing prevalence, it is going to be the greatest health challenge for India. To meet this formidable challenge, primary prevention is the need of the hour.