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Objectives: To determine whether changes in food patterns over a period of 6 years were related to obesity in Tehranian adults. Design: Data on dietary intake, using the food frequency questionnaire, and anthropometry were obtained in 2 periods of the survey (1999-2001 and 2005-2007). Setting: Participants of the Tehran Lipid and Glucose Study. Participants: Two hundred six adults. Main outcome measures: Waist circumference, body mass index, and waist-to-hip ratio. Analysis: Food patterns were derived using factor analysis. Results: Three dietary patterns, the healthful (HDP), the western (WDP), and the mix, were identified. Increased WDP score was directly related to change in body mass index (beta = 0.41, R[superscript 2] = 0.22, P less than 0.001) among overweight/obese individuals. Alterations in waist circumference was better predicted by increased WDP score (beta = 0.49, R[superscript 2] = 0.21, P less than 0.01) than by increased HDP score (beta = -0.20, R[superscript 2] = 0.11, P less than 0.05). Subjects in the higher quartile of increased HDP score had lesser change in waist-to-hip ratio (beta = -0.77, R[superscript 2] = 0.43, P less than 0.01). Conclusions and Implications: Results of this study indicate that increased adherence to the WDP and decreased adherence to the HDP could contribute to obesity. (Contains 2 figures and 4 tables.)