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This study evaluated changes in the prevalence of obesity, underweight, and wasting in women of reproductive age from Dar es Salaam, Tanzania, during the past 10 years and to identify contemporary sociodemographic correlates of these indicators. We estimated the prevalence of obesity [body mass index (BMI; in kg/m2) > or = 30], underweight (BMI < 18.5), and wasting (mid upper arm circumference < 22 cm) in 73 689 women aged 14-52 y who attended antenatal care clinics in the city of Dar es Salaam, Tanzania, between 1995 and 2004. The prevalence of obesity rose steadily and progressively from 3.6% in 1995 to 9.1% in 2004 [adjusted prevalence ratio (PR): 1.97; 95% CI: 1.66, 2.33; P for trend for year < 0.0001]. Underweight showed only a modest decline from 3.3% in 1995 to 2.6% in 2004 (adjusted PR: 0.91; 95% CI: 0.75, 1.10; P for trend for year = 0.003), whereas no change was observed in the prevalence of wasting. In the most recent years (2003 and 2004), obesity was positively associated with age, parity, and socioeconomic status and inversely with HIV infection. Underweight was inversely related to socioeconomic status and positively to HIV status. Conclusions: The recent, rapid, and large increase in the prevalence of obesity in women represents a new competing public health priority in urban Tanzania, where underweight and wasting have not decreased substantially. Future studies need to examine the implications of the fast increase in obesity on the incidence of diabetes, hypertension, cardiovascular disease, cancer, and other noncommunicable diseases in this population. Increasing knowledge on the specific causes of obesity in this population, through research on patterns of dietary intake and physical activity, should provide clearer directions for the implementation of culturally tailored public health interventions. It is critical to promote and strengthen surveillance mechanisms to follow trends in the nutritional status of populations in sub-Saharan Africa.