Tanzania Journal of Agricultural Sciences, 2016; 15 (2): 81-92Overweight and obesity are malnutrition which needs great attention due to their health consequences. A cross-sectional study was conducted on 362 adults aged 25-55 years in 2012 to examine the prevalence of overweight, obesity and risk factors through; assessing nutritional status, dietary intake and physical activities in lowland and highland areas of Same District, Kilimanjaro Region. Demographic, dietary intake and physical activity were obtained using a structured questionnaire. Weight, height, waist and hip circumferences were determined using standard WHO procedures. Data were analyzed using Statistical Product and Service Solutions version 16, excels and NutriSurvey 2007 program. The prevalence of overweight was 23% and obesity 17%. Women were more than 4 times likely to be overweight and obese compared to men (OR 5.53, 95% CI: 3.11 – 9.82). Lowland had high prevalence of overweight and obesity compared to highland areas (OR 2.034, 95% CI: 1.138-2.952). About 33% of lowland subjects had excess energy intake compared to 23% of highland (p=0.050). Positive energy balance was significantly associated with overweight and obesity (OR 1.12, 95% CI: 0.66 – 1.91). The mean Physical Activity Level for highland was 2.2 compared to 1.87 of lowland areas (p<0.05). Overweight and obesity was significantly related to income, sex, residence, education, farming technology, carrying produce, occupation, employment, energy balance and age (P<0.005). The high prevalence of overweight and obesity especially in lowland may be due to physical activities and energy intake which are controllable. These findings will assist health stakeholders to allow design of appropriate interventions to reduce the problems.