Public Health Nutrition: 3(1), 3–10 3 Patterns of body weight in the Baltic Republics Joceline Pomerleau 1 , Iveta Pudule 2 , Daiga Grinberga 2 , Kamelija Kadziauskiene 3 , Algis Abaravicius 4 , Roma Bartkeviciute 3 , Sirje Vaask 5 , Aileen Robertson 6 and Martin McKee 7, * 1 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK: 2 Health Education Division, Health Promotion Centre, Skolas 3, LV-1010 Riga, Latvia: 3 National Nutrition Centre, Kalvariju str. 153, 2042 Vilnius, Lithuania: 4 Faculty of Medicine, Department of Physiology and Biochemistry, Vilnius University, Ciurlionio str. 21/27, 2009 Vilnius, Lithuania: 5 Public Health Department, Ministry of Social Affairs, Gonsiori str. 29, EE0100 Tallinn, Estonia: 6 WHO Regional Officer for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark: 7 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK Submitted 16 November 1998; Accepted 6 July 1999 Abstract Objective: Previously recorded rates of obesity in the Baltic Republics have been among the highest in the world although little is known about how they vary within the population. This study investigates the distribution of body mass index (BMI) and obesity in these countries. Design: Three cross-sectional surveys conducted in the summer of 1997. Setting: Estonia, Latvia and Lithuania. Subjects: Representative national samples of adults with measured weight and height (Estonia: n = 1154; Latvia: n = 2292; Lithuania: n = 2096). Results: Between-country differences are particularly large among women: women from Latvia and Lithuania are approximately three times as likely to be obese as those from Estonia (17.4%, 18.3%, 6.0% respectively); only about one-third of this difference is explained by the sociodemographic and behavioural factors studied. In men, the prevalence of obesity varied only slightly among countries (Estonia: 9.9%; Latvia: 9.5%; Lithuania: 11.4%). While the prevalence of obesity increases with age within each republic, particularly in women, it is not associated with nationality or urban/ rural region, and no consistent association is observed with income. Obesity is inversely related to education in Latvia and in Lithuanian women. Latvian men and women and Lithuanian men who smoked had a lower prevalence of obesity than non-smokers. Leisure time physical activity was not associated with obesity. Conclusions: Obesity is a major health problem in the Baltic Republics, particularly among Latvian and Lithuanian women. The lack of association between obesity and most demographic, socioeconomic and behavioural factors suggests that the problem is generalized. Health promotion strategies aiming at preventing and controlling excess weight gain in the Baltic Republics will need to target the general population. Keywords Obesity Diet Latvia Lithuania Estonia There is now a large volume of evidence showing that obesity is strongly associated with rates of total mortality, with those having a BMI greater than 30 kg m -2 (the standard definition of obesity) typically experiencing a relative risk of death that is more than double that of people of average weight 1–3 . Obesity is associated specifically with a range of common non-communicable diseases, such as hypertension 4 , cardiovascular disease 5,6 , stroke 7 , certain cancers 8,9 and diabetes mellitus 10,11 . Obesity is an issue of particular concern in the Baltic Republics and in other parts of the former Soviet Union, where data from multinational surveys have found rates that are among the highest in the world. For example, data from the WHO MONICA study, collected between 1983 and 1988, placed the five centres in the former Soviet Union among the top six positions of 48 centres world-wide in terms of female obesity, with Kaunas in Lithuania occupying the highest position 12 . Among men the position of the former Soviet centres was not so bad, although here Kaunas ranked third overall. These countries also have extremely high levels of many of the diseases associated with obesity. For example, the age-standardized death rates per 10 000 people from ischaemic heart disease in 1994 were 410 in Estonia, 406 in Latvia and 397 in Lithuania, which contrast with the European Union average of 117 13 . However, while overall  2000 Nutrition Society * Corresponding author: Email m.mckee@lshtm.ac.uk