Obesity-related eating behaviours in the adult population of Spain, 2008-2010.

Knowledge of the socio-demographic distribution of eating behaviours can aid our understanding of their contribution to the obesity epidemic and help to address healthy eating interventions to those who can benefit most. This cross-sectional study assessed the frequency of self-reported eating behaviours among 11,603 individuals representative of the non-institutionalized Spanish population aged ≥ 18 years in the period 2008-2010. In the adult population of Spain, 24.3% had lunch and 18.2% had dinner away from home >3 times per month. About three-fourths of adults did not plan the amount of food to be eaten, and did not choose light foods and/or skim dairy products. Also, 26% did not trim visible fat from meat, and 74.7% usually ate while watching television. Compared with individuals with primary or less education, those with university studies were more likely to remove fat from meat (age- and sex-adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.08-1.44), and to choose light food and/or skim dairy (aOR 1.50; 95% CI 1.30-1.77), and less likely to eat while watching television (aOR 0.54; 95% CI 0.47-0.63). In conclusion, the prevalence of several obesity-related eating behaviours is high in Spain, which indicates a deficient implementation of dietary guidelines. Socioeconomic inequalities in eating behaviours should also be addressed.

Prevalence of general and abdominal obesity in the adult population of Spain, 2008-2010: the ENRICA study.

This is the first study to report the prevalence of general obesity and abdominal obesity (AO) in the adult population of Spain based on measurements of weight, height and waist circumference. The data are taken from the ENRICA study, a cross-sectional study carried out between June 2008 and October 2010 in 12,883 individuals representative of the non-institutionalized population on Spain aged 18 years and older. Anthropometry was performed under standardized conditions in the households by trained interviewers. Overweight was considered as body mass index (BMI) 25-29.9 kg m(-2) , and obesity as BMI ≥ 30 kg m(-2) . AO was defined as waist circumference >102 cm in men and >88 cm in women. The prevalence of obesity was 22.9% (24.4% in men and 21.4% in women). About 36% of adults had AO (32% of men and 39% of women). The frequency of obesity and of AO increased with age and affected, respectively, 35 and 62% of persons aged 65 and over. The frequency of obesity and AO decreased with increasing educational level. For example, 29% of women with primary education or less had obesity vs. only 11% of those with university studies. The prevalence of obesity was very high in the Canary Islands and in the south of Spain.

Heterogeneous trend in smoking prevalence by sex and age group following the implementation of a national smoke-free law.

OBJECTIVE: Given the limited evidence available about the effects of clean indoor air laws on smoking behaviour in the general population, the impact of national smoke-free workplace, bar and restaurant legislation, implemented on 1 January 2006, on smoking prevalence in Spain was assessed in this study. METHODS: Population-based trend analysis using estimates for 27 periods from the beginning of 2000 to the end of 2008-three periods per year. To calculate the period per cent change in smoking prevalence, the permutation test for joinpoint regression to detect significant changes was used. RESULTS: In men and women aged 15-24 years, the prevalence of smoking declined between the first period in 2000 and the third period in 2008, whereas in women aged 45-64 years, it increased by 1.7% per period. A declining trend was detected up to the first period in 2006 in men and women aged 25-44 years and in men aged 45-64 years, but between the beginning of 2006 and the end of 2008 the prevalence of smoking increased by 1.2%, 0.7% and 2.0% per period in men aged 25-44 years, in women aged 25-44 years and in men aged 45-64 years, respectively. CONCLUSIONS: 3 years after a national smoke-free law was implemented, the trend in smoking prevalence in some population groups was unchanged; however, in others, the declining trend of previous years was reversed. The similarity of these findings to those observed in other countries suggests that clean indoor air laws, although effective in reducing exposure to second-hand smoke, may not achieve the secondary objective of reducing the prevalence of smoking in the population.

Trends in overweight and misperceived overweight in Spain from 1987 to 2007.

OBJECTIVE: To examine trends in overweight and misperceived overweight in adults (≥ 20 years) and children (5-15 years) of Spain from 1987 to 2007. METHODS: Data were obtained from five cross-sectional studies, representative of the population of Spain in 1987, 1995, 1997, 2001 and 2006/2007. Self-reported weight and height were used to obtain the body mass index (BMI). Overweight was defined in adults as BMI of ≥ 25 kg m⁻², and in children using age- and sex-specific BMI cutoffs proposed by the International Obesity Task Force. People with overweight were considered to have misperceived overweight when adults considered their weight or their child's weight to be normal or less than normal. RESULTS: From 1987 to 2006/2007, the prevalence of overweight increased in absolute terms by 14.1% in men and 10.3% in women. Concurrently, the frequency of misperceived overweight remained relatively stable, approximately 35% in men, but rose from 16.5 to 20.8% in women. From 1995/1997 to 2006/2007, the prevalence of overweight increased in absolute terms by 3.2% in boys and 4.6% in girls. Over the same period, there was an absolute 8% increase in misperception of overweight among children of both sexes. As a result, during 2006/2007, approximately 60% of parents did not correctly perceive the weight status of their overweight children. Moreover, misperceived overweight was highest for younger children, and for those whose parents had a higher education. CONCLUSIONS: The obesity epidemic in Spain has been accompanied by an increased misperception of overweight in women and children of both sexes. Our results warn of the low family's readiness to modify the environment and lifestyle needed to control overweight.

Trends in principal cancer risk factors in Spain.

Using data furnished by successive national health surveys, this article describes trends in the prevalence of smoking, physical inactivity, obesity, consumption of fruit and vegetables, and excessive alcohol consumption in Spain. For most of these factors, trends are shown since the end of the 1980s, and in the case of smoking, since the end of the 1970s. The findings indicate decreases in smoking--except among women aged 45-64 years--physical inactivity and high-risk alcohol consumption, and increases in consumption of fruit and vegetables, and obesity. The inclusion of these risk factors in cancer prevention strategies continues to be a matter of priority, in some cases because they display high prevalences despite their downward trend, as occurs with smoking among men and physical inactivity in the overall population, and in others because they display an upward trend, e.g. smoking among women aged 45-64 years and obesity in the overall population.

Eating behaviours and obesity in the adult population of Spain.

To examine the association between several eating behaviours and obesity, data were taken from a cross-sectional study conducted with 34,974 individuals aged 25-64 years, representative of the non-institutionalised Spanish population. Obesity was defined as BMI >or= 30 kg/m2. Study associations were summarised with OR obtained from logistic regression, with adjustment for socio-demographic and lifestyle factors. The results showed that those skipping breakfast were more likely to be obese, both in men (OR 1.58; 95 % CI 1.29, 1.93) and women (OR 1.53; 95 % CI 1.15, 2.03). Moreover, obesity was more prevalent in those having only two meals per day than in those having three or four meals in men (OR 1.63; 95 % CI 1.37, 1.95) and women (OR 1.30; 95 % CI 1.05, 1.62). Also, snacking was associated with obesity in women (OR 1.51; 95 % CI 1.17, 1.95). However, no association was observed between obesity and having one or more of the main meals away from home, in either sex. In conclusion, skipping breakfast and eating frequency were associated with obesity. The lack of association between eating away from home and obesity is in contrast to most previous research conducted in Anglo-Saxon countries. Differences in the type of establishment frequented when eating out or in the characteristics of restaurant customers in a Mediterranean population might explain these conflicting results.

Impact of cumulative area-based adverse socioeconomic environment on body mass index and overweight.

OBJECTIVE: Although the relationship between area socioeconomic environment and obesity is known, previous research has measured area socioeconomic environment at only one point in time. This study evaluates the relationship of cumulative area-based adverse socioeconomic environment with body mass index (BMI) and overweight. DESIGN: Cross-sectional study. SETTING: Spain. PARTICIPANTS: 17 917 subjects in 2001. MAIN OUTCOME MEASURE: Information from 1980, 1990 and 2000 was used for the percentage of the population with low educational achievement, gross domestic product per capita (GDPpc), and Gini coefficient to estimate BMI and prevalence of overweight by the number of times each province had an adverse exposure to each of these measures of socioeconomic environment. RESULTS: After adjusting for individual variables and sports facilities in the area, the difference in BMI in residents of provinces with the highest percentage of population with low educational achievement in 1980, 1990 and 2000, compared with residents of provinces with no history of adverse socioeconomic environment based on this indicator, was 0.61 kg/m(2), whereas the prevalence of overweight was 1.46 times higher. Similar results were obtained for residents of provinces with cumulative low GDPpc versus residents of provinces that had never had low GDPpc. Neither BMI nor overweight were associated with cumulative income inequality based on the Gini coefficient. CONCLUSION: Cumulative adverse socioeconomic environment based on indicators of educational level or wealth, but not of income inequality, is positively associated with BMI and overweight. This association is not explained by individual characteristics or by the availability of sports facilities.

Influence of childhood socioeconomic circumstances, height, and obesity on pulse pressure and systolic and diastolic blood pressure in older people.

This study assesses the association of childhood socioeconomic circumstances, height, and obesity with components of blood pressure. We selected 4009 people representative of the Spanish population aged 60 years and older, and estimated systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) according to childhood social class, height, and obesity. No association was found between childhood social class and blood pressure. SBP showed an inverse gradient and DBP a direct gradient with height, although an independent association between height and DBP was found only in women. Stature was independently associated with increased DBP in women with central obesity, but there was no association between height and DBP in women without central obesity. Short stature was independently associated with increased PP. Body mass index and waist-to-hip ratio were independently associated with increased DBP in women, and waist-to-hip ratio was independently associated with increased PP in men, while waist circumference was independently associated with increased DBP and increased PP in women. These results do not support the assumed effect of socioeconomic circumstances in early life on blood pressure, which may depend on the context and/or study population. The relations observed between height and blood pressure support the hypothesis that PP could be a mediator of the association between short stature and increased cardiovascular risk. The relationship between obesity measures and components of blood pressure reinforces the recommendation to reduce body weight in order to reduce blood pressure.

Changes in body weight and health-related quality-of-life in the older adult population.

BACKGROUND: No other study has ascertained the short-term impact of weight change on health-related quality-of-life (HRQL) on a national sample of older adults. OBJECTIVE: To examine the relationship between change in body weight and HRQL among the older adult population. METHODS: We carried out a prospective study from 2001 to 2003 of a cohort of 2364 persons, representative of the noninstitutionalized Spanish population aged 60 y and over. Weight changes during the period 2001-2003 were self-reported, and HRQL in 2003 was measured with the SF-36 questionnaire. Analyses adjusted for the principal confounders. RESULTS: Among nonobese women (body mass index (BMI) 18.5-29.9 kg/m(2)), and compared to those who underwent no important weight change, weight loss was associated with a clinically significant worsening in the role-physical, vitality, and social functioning SF-36 scales. Among obese women (BMI> or =30 kg/m(2)), weight gain led to a reduction in HRQL for four of the eight SF-36 scales, while weight loss was associated with worse scores in role-emotional and mental health scales. Results were usually similar for men, though of lower magnitude. In both sexes, weight change was associated with a reduction of over 5 points on several physical and mental scales of the SF-36, which indicates a clinically relevant worsening in HRQL. CONCLUSION: Weight change is associated with worse HRQL among the older adults, principally women. From the stance of HRQL, it is desirable to prevent weight gain, especially among the obese, and weight loss, especially among the nonobese.

Obesity and socioeconomic position measured at three stages of the life course in the elderly.

OBJECTIVE: To investigate the association between socioeconomic position, measured at three stages of the life course, and obesity in the elderly. DESIGN: Cross-sectional study carried out in 2000-2001. SUBJECTS: In total, 4009 subjects aged 60 y and older, representative of the Spanish noninstitutionalised population. RESEARCH METHODS AND PROCEDURES: We estimated body mass index (BMI) and waist circumference (WC) by social class in childhood, by educational level and by adult social class, as well as the association between these two obesity measures and each socioeconomic characteristic after adjusting for the other two. RESULTS: In men, no relation was found between the two measures of obesity studied and socioeconomic circumstances throughout the life course. Nor was any relation found in women between social class in childhood and the two measures of obesity after adjusting for the other two socioeconomic variables. In contrast, BMI and WC in women showed a statistically significant inverse gradient with educational level and with adult social class after adjusting for age and the rest of the socioeconomic variables. CONCLUSIONS: In general, these results support the small amount of existing evidence on the association between obesity and abdominal obesity and socioeconomic position by educational level and adult social class. The results for social class in childhood do not support the existing evidence, and suggest that this association may depend on specific historic and cultural circumstances.

Relation between body weight and health-related quality of life among the elderly in Spain.

OBJECTIVE: This study examines the relation between body weight and the physical and mental components of health-related quality of life (HRQL) in the population aged 60 y and over in Spain. RESEARCH METHODS AND PROCEDURES: Cross-sectional study covering 3605 subjects, representative of the noninstitutionalised Spanish population aged 60 y and over. Information was collected through home-based personal interview and measurement of blood pressure and anthropometric variables. Logistic regression was used to examine the relation of suboptimal HRQL (score<100) on each SF-36 questionnaire scale with body mass index (BMI) and waist circumference. Separate regression models were constructed for each sex and adjusted for sociodemographic variables, tobacco and alcohol consumption, physical activity, arterial hypertension and diagnosed chronic disease. RESULTS: Mean age of the study population was 70.9 y for men and 72.2 y for women. The percentage of overweight subjects was 48.5% in men and 39.8% in women, and of obese subjects, 31.9 and 41.1% respectively. Men registered a better HRQL than women on most of the SF-36 scales. Compared to normal-weight subjects (BMI: 18.5-24.9 kg/m(2)), frequency of suboptimal physical functioning was higher among obese subjects (BMI>or=30 kg/m(2)), both male (OR: 1.91; 95% CI: 1.22-3.00) and female (OR: 2.58; 95% CI: 1.59-4.19). The aspects of physical functioning most affected were bending, kneeling or stooping, climbing stairs and strenuous effort. Male, though not female, obesity was nonetheless associated with a better HRQL on the SF-36 mental scales. Frequencies of suboptimal scores for overweight persons (BMI: 25-29.9 kg/m(2)) were similar to those for normal-weight subjects on most of the SF-36 scales. Results proved similar for subjects in both the 60-74 and 75-and-over age groups, and also when waist circumference was used as the measure of obesity (>102 cm in men and >88 cm in women). CONCLUSIONS: Obese men and women showed worse physical functioning than normal-weight persons. This occurred irrespective of whether subjects were over or under 74 y of age, or whether obesity was measured by BMI or waist circumference, and was not explained by unhealthy lifestyles or obesity-related chronic disease.

A simple estimate of mortality attributable to excess weight in the European Union.

OBJECTIVE: To estimate the current burden of mortality attributable to excess weight in the European Union (EU). METHODS: Prevalence of overweight (body mass index, BMI 25-29.9 kg/m(2)) and obesity (BMI >or=30 kg/m(2)) were based on self-reported data from a survey with samples representative of the 15 EU Member States in 1997. Primary source of relative risk (RR) of death by BMI was the first American Cancer Prevention Study (CPS I). Additional calculations were performed to account for effect of smoking (using CPS I data for non- or never-smokers), for pre-existing illness (using the second CPS, CPS II, data for healthy never-smokers) and using RRs derived from European rather than US data (using data from a meta-analysis of prospective studies). Mortality attributable to excess weight was calculated by combining the prevalences of overweight and obesity, the RRs, and the number of deaths in the EU countries. RESULTS: Annual deaths attributable to overweight and obesity totalled approximately 279 000 when RRs for all subjects were used. When RRs for nonsmokers only were applied to the entire population, about 304 000 deaths were attributable to excess weight. In analyses using RRs which controlled for both smoking and history of disease, the number of deaths attributable to excess weight was estimated at about 337 000 based on European data and at about 401 000 based on US data. In the EU, therefore, a minimum of 279 000 deaths were attributable to excess weight (7.7% of all deaths, varying from 5.8% for France through 8.7% for the UK). More attributable deaths occurred among the obese (175 000) than among the overweight (104 000). Around 70% were cardiovascular disease deaths (195 000) and 20% cancer deaths (53 000). CONCLUSION: Mortality attributable to excess weight is a major public health problem in the EU. At least one in 13 annual deaths in the EU are likely to be related to excess weight.

Self-perception of being overweight in Spanish adults.

OBJECTIVE: To describe the frequency, distribution and trend in misperceived overweight and obesity. DESIGN: Three independent cross-sectional studies carried out in 1987, 1995 and 1997 over representative samples of Spanish adult population. SETTING: Spanish adult population aged 20 y and over. SUBJECTS AND INTERVENTIONS: A total of 11 496 men and women aged 20 y and over with a body mass index (BMI) >or=25 kg/m(2). MAIN OUTCOME MEASURES: Prevalence and time trend of misperceived overweight and obesity based on self-perceived weight and height. RESULTS: Some 28.4% of the population did not perceive themselves to be overweight or obese in 1987 (26.9% in 1995/97). Overweight was more frequently misperceived among men, persons over 64 y of age, those residing in rural areas and those with an elementary educational level. The largest percentages of misperceived overweight were in the more moderate levels of BMI: 50% of men and 30% of women with a BMI of 25-26.9 kg/m(2) in 1995/1997 did not perceive themselves to be overweight. CONCLUSIONS: Misperceived overweight and obesity is frequent in the adult population in Spain. Some social and cultural factors may explain its higher frequency in men, older individuals and those with elementary level of education. The fact that most of those who do not perceive themselves to be overweight are in the moderate levels of overweight should be taken into account when designing strategies for the prevention and control of overweight and obesity in the general population.

The size of obesity differences associated with educational level in Spain, 1987 and 1995/97.

OBJECTIVE: To determine the size of obesity differences associated with educational level in the adult population in Spain. DESIGN: Three cross sectional studies representative of the adult population in Spain were carried out in 1987, 1995, and 1997. SETTING: The general population in Spain. PARTICIPANTS: 11 461 men and 10 219 women aged 25 to 64 years. MAIN RESULTS: For both men and women the obesity prevalence was highest in those with elementary education. In 1987 the obesity prevalence proportion associated with less than third level education (PA) was 24.5% (95% CI 6.0 to 42.8) and 47.9% (15.7 to 71.8) in men and women, respectively. The PAs in 1995/97 were 19.8% (0.2 to 40.2) and 55.1% (21.3 to 72.8). CONCLUSIONS: In 1995/97 the burden of obesity associated with less than third level education was 20% in men and 55% in women aged 25 to 64 years. Between 1987 and 1997 the obesity prevalence proportion associated with less than third level education increased in women and decreased in men.

The relationship of overweight and obesity with subjective health and use of health-care services among Spanish women.

OBJECTIVE: To examine the relationship of overweight and obesity with subjective health and use of health-care services among women in Spain. METHODS: Data were drawn from the 1993 Spanish National Health Survey, covering a 13 244-woman sample representative of the non-institutionalised Spanish population aged 16 y and over. Information was collected through home-based interviews. Multiple logistic regression models were used to calculate odds ratios for suboptimal health (fair, poor or very poor) and utilisation of health-care services by women with normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)) and obesity (BMI>or=30 kg/m(2)). Analyses were adjusted for age, education level, occupation, civil status, social support, tobacco use, alcohol consumption, physical activity at work and during leisure time, job status and town of residence. RESULTS: Frequency of suboptimal health was higher in women with overweight (OR 1.7; 95% CI 1.5-1.9) and obesity (OR 2.1; 95% CI 1.8-2.5) than in those with normal weight. Overweight and obese women visited the physician, used hospital emergency services and took medication with greater frequency than did women of normal weight. There was a positive dose-response relationship (P<0.05) of BMI>or=18.5 kg/m(2) with suboptimal health and utilisation of health-care services. These associations were not wholly explained by BMI-related risk factors and chronic diseases, since their statistical significance remained unchanged and their magnitude was only slightly reduced after adjustment for those factors. The association of overweight and obesity with the use of health-care services did not vary with age, educational level or presence of chronic disease. CONCLUSION: Overweight and obese women have worse subjective health and make greater use of health-care services. This finding is an additional argument for implementing weight-control programmes in Spain.

Trends in cigarette smoking in Spain by social class.

OBJECTIVE: . The aim of this study was to evaluate smoking trends among Spanish men and women by social class between 1987 and 1997. METHODS: We used secondary analysis of the National Health Interview Surveys of 1987, 1993, 1995, and 1997. The main outcome measures were prevalence of smoking, smoking cessation activity (quit ratio), and smoking initiation in the manual and nonmanual social class in each year and smoking prevalence ratio, smoking cessation ratio, and smoking initiation ratio in 1997 versus 1987 in each social class. RESULTS: Among men ages 25 years and older the prevalence of smoking in both the manual and the nonmanual social class decreased between 1987 and 1997 in all age groups, and the relative magnitude of the decrease was always greater in the nonmanual social class. In contrast, among women the prevalence of smoking increased in both social classes: in the 25- to 44-year age group the smoking prevalence ratios in 1997 versus 1987 were 1.20 in the nonmanual social class and 1.61 in the manual social class, while in the 45- to 64-year age group the prevalence ratios were 2.52 and 2.15, respectively. The quit rate among men increased in both social classes in all age groups between 1987 and 1997; in contrast, among women the quit rate increased only among those ages 25 to 44 years in the nonmanual social class. Smoking prevalence for people ages 16 to 24 years--smoking initiation--decreased among men and women between 1987 and 1997 in both social classes. CONCLUSIONS: Smoking trends in Spain by social class have differed among men and women. The findings are considered in the context of policies and programs aimed at reducing smoking.

Obesity and body mass index in Spain: the 'single population' theory revisited.

OBJECTIVE: The 'single population' theory suggests that the distribution of body mass index (BMI) moves up and down as a whole. We test directly whether this theory is valid among the adult population within one country over time, by examining the association between median BMI and the prevalence of obesity in the adult population of Spain's 17 regions between 1987 and 1993. DESIGN AND SETTING: Ecological study using data from two national health surveys. SUBJECTS AND INTERVENTIONS: Self-reported weight and height for persons aged 20-64 y were drawn from representative Spanish-population samples from two similar National Health Surveys carried out in 1987 (n = 20 705) and 1993 (n = 15 490). MAIN OUTCOME MEASURES: Correlation and linear regression between the difference in median BMI and the difference in the prevalence of obesity (BMI > or = 30 kg/m(2)) between 1987 and 1993. RESULTS: Between 1987 and 1993 the change in median BMI was in general strongly correlated with the change in the prevalence of obesity (r = 0.85; P < 0.001). The correlation is greater in women, persons over 45 y, and those with lower educational levels. Between 1987 and 1993 each unit of increase in median BMI is associated with an absolute increase of 5.1% (95% CI 3.3-6.8%) in the prevalence of obesity. CONCLUSIONS: The single population hypothesis holds true among the adult population within a whole country over time. This could be useful for monitoring and understanding the prevalence of obesity within a population.

Month of birth and height of Spanish middle-aged men.

We examined whether body height differs in Spain, a country having a high number of hours of sunlight, between middle-aged males and females born during the months with the longest and those born in the months with the shortest periods of daylight hours. We used data from a cross-sectional survey that documented standardized measurements of height and other variables for a 2021-person random multi-stage sample representative of the Spanish population aged 35-64 years. The relationship between height and month of birth was analysed by multiple linear regression, adjusting for age, occupation and type of residence. Male adults born in summer proved to be 1.7 cm taller than their counterparts born in winter (95% confidence interval 0.2-3.3 cm, p = 0.03). This relationship was most marked for those whose occupation was non-manual (2.1 cm, p = 0.04 vs 1.4cm, p = 0.2 in manual occupations). No significant (p = 0.8) or relevant (0.16 cm) summer- and winter-related differences in height were found in women. These results are compatible with the hypothesis that adult male height could be partially influenced by physical environmental factors such as the action of sunlight during the early stages of life.

Educational differences in health expectancy in Madrid and Barcelona.

Educational differences in Health Expectancy (HE) among residents older than 24 years of age in Madrid and Barcelona are evaluated. Death records were linked to the 1991 Population Census and self-perceived health from the National Health Interview Survey was used. Differences between the higher and the lower educational groups in HE at 25 years were: 7.5 years in men and 5.58 years in women in Madrid and 9.5 years in men and 13.4 years in women in Barcelona. Since HE combines mortality and health status, results presented may have important implications for health policy.

Increasing prevalence of overweight and obesity among Spanish adults, 1987-1997.

OBJECTIVE: To study the trend in the prevalence of obesity and overweight in Spanish men and women 25-64 y of age between 1987 and 1997. DESIGN: Cross-sectional surveys of representative samples of the non-institutionalized population in Spain in 1987, 1995 and 1997. SUBJECTS: 14,676 and 7004 adults aged 25-64 who were representative of the Spanish population in 1987 and 1995/1997. MEASURES: Body mass index (BMI) calculated from self-reported weight and height. Overweight is defined as BMI = 27-29.9 kg/m2 and obesity as BMI > or = 30 kg/m2. RESULTS: Between 1987 and 1995/97, the prevalence of overweight in the Spanish population aged 25-64 increased by 2.2% (P < 0.01); the increase was greater in men (3.8%; P < 0.01) than in women (0.6%; P > 0.05). The largest increases in the prevalence of overweight were seen in men (5.2%; P < 0.01) and women (2.3%; P < 0.05) aged 25-34. During the same period, the prevalence of obesity increased by 3.9% (P < 0.01), 4.6% in men (P < 0.01) and 3.2% in women (P < 0.01). The largest increases were seen in men aged 45-54 (6.5%, P < 0.01) and in women aged 25-34 (2.2%, P < 0.05). By educational level, the prevalence of overweight increased significantly in men with fewer than 12 y of education (4.7%, P < 0.01). Obesity increased by 4.6% (P < 0.01) and by 4.9% (P < 0.01) in men and women with fewer than 12 y of education, respectively. CONCLUSIONS: The prevalence of overweight and obesity is increasing in Spain, the same as it is in other developed countries. The increase, which is found in most age and sex groups in the population, especially affects middle-aged men, young women and persons with lower educational level. The causes of the increase in the prevalence of overweight and obesity are likely to be multifactorial.