The clinical review by Jean-Pierre Després, Isabelle Lemieux, and Denis Prud'homme emphasizes the importance of focusing on high-risk abdominally obese patients due to the significant health risks associated with abdominal obesity. Despite the well-documented link between obesity and metabolic complications such as dyslipidaemia, type 2 diabetes, and cardiovascular diseases, the heterogeneity in metabolic risk factors among obese patients is perplexing. Epidemiological and metabolic studies over the past 15 years have highlighted that the location of excess fat, particularly in the abdominal region, is a more critical factor in determining health risks compared to overall body weight. Abdominal obesity, characterized by visceral adipose tissue accumulation, is a major risk factor for coronary heart disease, type 2 diabetes, and related mortality. The review discusses the clinical implications of this concept, focusing on the assessment and management of risk in abdominally obese patients. It highlights the importance of visceral adipose tissue measurement, which can be estimated using waist circumference and advanced imaging techniques like MRI and CT. The review also emphasizes the metabolic complications associated with visceral obesity, including glucose intolerance, hyperinsulinaemia, and atherogenic dyslipidaemia. These complications are linked to an increased risk of type 2 diabetes and coronary heart disease. The authors propose a simple screening algorithm using waist circumference and fasting triglyceride concentrations to identify high-risk abdominally obese individuals. They suggest that a waist circumference of 90 cm or more in men and 88 cm or more in women, combined with fasting triglyceride levels of 2 mmol/L or higher, can effectively identify those at high risk. This approach is particularly useful in refining the identification of high-risk patients beyond traditional measures like body mass index. The management of obesity should focus on treating the underlying metabolic complications rather than just weight loss. The review suggests that moderate weight loss (5-10%) can lead to significant improvements in metabolic markers, reducing the risk of acute coronary events in high-risk patients. A multifaceted approach, including balanced nutrition, increased physical activity, and targeted pharmacotherapy, is recommended to address the aetiology of metabolic complications associated with abdominal obesity.The clinical review by Jean-Pierre Després, Isabelle Lemieux, and Denis Prud'homme emphasizes the importance of focusing on high-risk abdominally obese patients due to the significant health risks associated with abdominal obesity. Despite the well-documented link between obesity and metabolic complications such as dyslipidaemia, type 2 diabetes, and cardiovascular diseases, the heterogeneity in metabolic risk factors among obese patients is perplexing. Epidemiological and metabolic studies over the past 15 years have highlighted that the location of excess fat, particularly in the abdominal region, is a more critical factor in determining health risks compared to overall body weight. Abdominal obesity, characterized by visceral adipose tissue accumulation, is a major risk factor for coronary heart disease, type 2 diabetes, and related mortality. The review discusses the clinical implications of this concept, focusing on the assessment and management of risk in abdominally obese patients. It highlights the importance of visceral adipose tissue measurement, which can be estimated using waist circumference and advanced imaging techniques like MRI and CT. The review also emphasizes the metabolic complications associated with visceral obesity, including glucose intolerance, hyperinsulinaemia, and atherogenic dyslipidaemia. These complications are linked to an increased risk of type 2 diabetes and coronary heart disease. The authors propose a simple screening algorithm using waist circumference and fasting triglyceride concentrations to identify high-risk abdominally obese individuals. They suggest that a waist circumference of 90 cm or more in men and 88 cm or more in women, combined with fasting triglyceride levels of 2 mmol/L or higher, can effectively identify those at high risk. This approach is particularly useful in refining the identification of high-risk patients beyond traditional measures like body mass index. The management of obesity should focus on treating the underlying metabolic complications rather than just weight loss. The review suggests that moderate weight loss (5-10%) can lead to significant improvements in metabolic markers, reducing the risk of acute coronary events in high-risk patients. A multifaceted approach, including balanced nutrition, increased physical activity, and targeted pharmacotherapy, is recommended to address the aetiology of metabolic complications associated with abdominal obesity.