Blood pressure and anthropometric measurements were taken for 231 children between 11 and 14 years in the Annapurna area of Central Nepal, a popular tourist destination. Children from villages on the tourist trail, whose lifestyles were generally more modernised, were compared with children from nearby villages off the tourist trail. Indications of greater modernisation on the trail included the findings that fathers of children living on the trail were less likely to work as farmers than fathers of those off the trail (P = 0.003), and children living on the trail were much more likely to have seen television (P < 0.001). Children on the tourist trail were taller and heavier (P < 0.001), and had higher body mass indices (P = 0.003) and biceps skinfolds (P = 0.005). They also had higher diastolic blood pressure than children living off the trail (P = 0.02). The differences in weight appeared to account for the effect of living on the trail on diastolic blood pressure, since when weight was added to the model it showed a significant association with diastolic blood pressure (P = 0.02) and the effect of location became nonsignificant. For the biceps skinfold and systolic blood pressure, there was a significant sex difference in the effect of living on the trail (P = 0.04 and P = 0.05 respectively), such that among girls there were greater increases associated with living on the trail than there were among boys. The findings suggest that lifestyle changes linked to the development of tourism in Nepal are associated from an early age with potentially deleterious changes in cardiovascular characteristics and demonstrate that such socioeconomic changes can have quite local effects. Am. J. Hum. Biol. 12:478-486, 2000. Copyright 2000 Wiley-Liss, Inc.