BACKGROUND: The aim of the present work was to evaluate the relationships between socio-demographic, clinical, lifestyle and psychological characteristics and the presence of obesity, among elderly individuals without known cardiovascular disease. METHODS: During 2005-2007, 553 elderly men and 637 elderly women (mean age 74 ± 7 years) from eight Mediterranean Islands in Greece and Cyprus were enrolled. The retrieved information included demographic, bio-clinical and dietary characteristics. The MedDietScore assessed adherence to the Mediterranean dietary pattern. RESULTS: The prevalence of obesity was 27% in males and 41% in females (P <0.001), while 48% of males and 39% of females were overweight. The prevalence of diabetes, hypercholesterolemia and hypertension was higher in the obese elderly than in the overweight or normal (P <0.001). After adjusting for various confounders, one unit increase in the MedDietScore was associated with 88% (P =0.07) lower likelihood of being obese; similarly, physical activity was associated with 81% lower likelihood of obesity (P <0.001). CONCLUSIONS: Roughly seven out of 10 of our elderly were overweight or obese, while the majority of them presented other co-morbidities, too. Greater adherence to the Mediterranean diet may reduce the burden of obesity among elderly individuals.