About 10 years ago the WHO defined obesity as a separate disease whereas in Austria until now it is often regarded as a cosmetical problem only. Many diseases like those of joints and spine are correlated to the body weight and the body mass index (BMI), but macrovascular events (cardiovascular and cerebrovascular) and early death are closer associated with the waist to hip ratio (WHR), indicating an abdominal, android fat distribution. This fat distribution tends toward higher insulin levels, dys- and hyperlipidemia and disturbances in glucose metabolism which can in part explain these associations in the light of the metabolic syndrome. In conclusion, there is no healthy overweight, but not all overweight patients share the same risk.