Recent trends in the American lifestyle, such as a high-fat diet and inactivity, have promoted the emergence of a metabolic disorder titled syndrome X. Although originally linked to non-insulin-dependent diabetes mellitus (NIDDM) and characterized by insulin resistance, syndrome X is now better described as a cascade of disorders encompassing not only NIDDM, but also hypertension, atherosclerosis, centrally distributed obesity, and dyslipidemia. Further pathology has been linked to syndrome X, such as polycystic ovary disease, microvascular angin, and the presence of acanthosis nigricans. Recognition and appropriate management of syndrome X will prevent deleterious patient outcomes that might occur without continuity of care in treating associated disorders. Pharmacological management of syndrome X includes the use of insulin-sparing antihyperglycemic agents and/or combination therapy and avoidance of several frequently prescribed medications. Clinicians need to initiate renewed efforts to provide lifestyle counselling to promote ideal body weight, since interpretation of research data concerning syndrome X reinforces that serious health consequences will result from obesity and inactivity.