OBJECTIVE: Clinic-based studies have shown that patients with human immunodeficiency virus (HIV) gain weight after initiation of antiretroviral therapy (ART). This study aimed to determine whether the scale-up of ART was associated with a population-level increase in body mass index (BMI) and blood pressure (BP) in a community with high HIV and obesity prevalence. METHODS: A household survey was conducted in rural KwaZulu-Natal before ART scale-up (in 2004) and when ART coverage had reached 25% (in 2010). Anthropometric data was linked with HIV surveillance data. RESULTS: Mean BMI decreased in women from 29.9 to 29.1 kg/m(2) (P = 0.002) and in men from 24.2 to 23.0 kg/m(2) (P