Objectives: To evaluate waist circumference (WC) as a screening tool for obesity in a Caribbean population. To identify risk groups with a high prevalence of (central) obesity in a Caribbean population, and to evaluate associations between (central) obesity and self-reported hypertension and diabetes mellitus. Design: Cross-sectional. Setting: Population-based study. Subjects: A random sample of adults (18 y or older) was selected from the Population Registries of three islands of the Netherlands Antilles. Response was over 80%. Complete data were available for 2025 subjects. Intervention: A questionnaire and measurements of weight, height, waist and hip. Main outcome measurement: Central obesity indicator (WC Z102 cm men, Z88 cm women). Results: WC was positively associated with age (65-74 y vs 18-24 y) in men (OR ¼ 7.7, 95% CI 3.4-17.4) and women (OR ¼ 6.4, 95% CI 3.2-12.7). Women with a low education had a higher prevalence of central obesity than women with a high education (OR ¼ 0.5, 95% CI 0.3-0.7). However, men with a high income had a higher prevalence of a central obesity than men with a low income (OR ¼ 1.7, 95% CI ¼ 1.1-2.6). WC was the strongest independent obesity indicator associated with self-reported hypertension (OR ¼ 1.7, 95% CI 1.4-2.0) and diabetes mellitus (OR ¼ 1.6, 95% CI 1.3-1.9). Conclusions: The identified risk groups were women aged 55-74 y, women with a low educational level and men with a high income. WC appears to be the major obesity indicator associated with hypertension and diabetes mellitus.