Background: Elevated BMI and central adiposity increase the risk of cardiovascular disease, type 2 diabetes, and several cancers. Obesity has risen in recent decades, with Northern Sweden exceeding the national average. Anthropometric trends in the Northern Sweden MONICA study have not been updated since 2004.

Objective: To describe overweight and obesity trends in Northern Sweden from 1986 to 2022.

Methods: Eight population-based surveys were conducted between 1986 and 2022 within the Northern Sweden MONICA study. In each survey, 2000–2500 adults aged 25–74 years were invited; 12,950 participated (mean age 49.5 [SD 13.6]; 51% women), with a 68.2% response rate. Anthropometry was assessed using standardized protocols.

Results: Obesity increased by 15.7 percentage points in men and 12.1 percentage points in women. By 2022, obesity had doubled since 1986, reaching 26.6% in men and 26.3% in women. Abdominal obesity also increased: with waist circumference ≥ 102 cm in men and ≥ 88 cm in women rising by 21.5 and 4.9 percentage points, respectively.

Conclusions: General and abdominal obesity have substantially increased in Northern Sweden over the past four decades. These findings call for urgent, coordinated, and multi-level interventions, as continued increases in obesity pose serious long-term risks to population health and healthcare sustainability.