OBJECTIVE: To record the prevalence of overweight, obesity and hypertension in primary schoolchildren living in one of the poorest regions in Europe and furthermore to identify certain behavioural, lifestyle and physiological parameters associated with body mass index (BMI) and blood pressure (BP). DESIGN: Cross-sectional study. SETTING: Nineteen primary schools within the county of Ioannina, Greece. SUBJECTS AND METHODS: Demographic, dietary and physical activity data as well as anthropometrical, BP and cardiorespiratory fitness measurements were obtained from a representative sample of 312 school children (153 boys and 159 girls) attending 5th grade. Inclusion of subjects in the study was voluntary. One-way analysis of variance and multiple linear regression analysis were mainly applied for the evaluation of the tested hypotheses. RESULTS: The prevalence of overweight and obesity was 29.4 and 11.8% for boys and 39.0 and 7.5% for girls. The prevalence of systolic and diastolic hypertension was 28.1 and 7.8% for boys and 26.4 and 17.0% for girls. Furthermore, BMI and BP (systolic and diastolic) were positively related to frequency of fast food meals (rho: + 0.28, P = 0.033, rho: + 1.09, P = 0.03 and rho: +0.86, P = 0.014, respectively) but negatively to leisure time physical activity (rho: -5.55, P = 0.005, rho: -3.32 x 10(-2), P < 0.001 and rho: -2.08 x 10(-2), P < 0.001, respectively). CONCLUSIONS: The current study revealed an increased prevalence of overweight, obesity and hypertension among schoolchildren in Ioannina, indicating the need for early preventive measures in one of the less privileged regions of Europe.