Healthcare professionals spend a great deal of their time screening for, and treating, silent killer diseases such as diabetes, hypertension and hyperlipidaemia but often ignore the primary cause of these conditions, which is often – quite literally – staring them in the face. Obesity can be seen without the need to use any fancy gadgets – we simply need to use our eyes each time we see a patient. There are essentially two main body shapes – apples and pears – each associated with different distributions of body fat. Pearshaped people carry most of their excess fat around the hips, buttocks and thighs. Apples carry most of their excess body fat around the middle; this is known as central obesity and is much riskier for diabetes and cardiovascular disease. In this article we review why central obesity matters, how to measure it and management strategies.