This joint scientific statement is titled “Harmonizing the Metabolic Syndrome” as it represents an attempt to move towards developing a single worldwide definition for the Metabolic Syndrome. The consensus meeting involved the International Diabetes Federation (IDF), The US National Heart, Lung, and Blood Institute (NHLBI), the American Heart Association (AHA), the World Heart Federation (WHF), the International Atherosclerosis Society (IAS) and the International Association for the Study of Obesity (IASO) with the American Diabetes Association (ADA) conspicuously absent. The recommendations presented here chose to keep it simple and not include a measure of insulin resistance, as has been the recent trend in Metabolic Syndrome (MS) definitions. The focus is on how to incorporate the waist circumference (WC) into the criteria. The conclusion was to not make it obligatory but to work to refine the ethnic specific cutpoints. Interestingly, they did not make any changes in the other criteria. Namely, neither the TG, BP nor glucose cutpoints were not lowered. Nor were any other components, such as fatty liver or uric acid were added. They did make the point that most people with Type 2 Diabetes Mellitus will have the Metabolic Syndrome and use this to emphasize the point that DM is to be considered a CHD risk equivalent. Unfortunately, they do not address the point of using the MS to identify people to screen early for DM. Clearly this definition is still in evolution. The addition of more specific ethnic cutpoints for WC is of value and a step forward towards a unified worldwide definition for the MS. Kittie Wyne, MD, PhD, FACE