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Background: The increasing prevalence of obesity and overweight in Canada is a significant health concern. Unfortunately, we know very little about the actual weight status and associated health risks in our population since most surveys use only self-reported body weights and heights and typically do not include a measure of body fat distribution. This paper summarizes the findings of the Prince Edward Island Nutrition Survey., Methods: A random sample of 1,995 adults aged 18-74 were interviewed in their homes and weights, heights and waist circumference measurements were obtained. Relative health risks, population proportions and their corresponding 95% confidence intervals were calculated., Results: Overall, almost one third of PEI adults are obese (BMI > or = 30). This is almost double that reported in the 1995 National Population Health Survey using self-reported heights and weights. More women were classified as being very severely obese (Class III) than men, but for both men and women there appears to be a trend of increased mild obesity with age. Based on BMI and waist circumference, over one third of the population is considered to be at high to extremely high risk for health problems., Conclusion: Self-reported height and weight data appear to result in significant underestimation of the problem of obesity. Given the serious health consequences associated with this condition, it is critical that measured heights and weights be collected in future population-based surveys to ensure that public health interventions are based on accurate prevalence data.