This study determined the association between overweight and obesity, demographic variables, elevated blood pressure, and frequency of health care referrals in rural adolescents. Annual school health screenings were conducted. Analysis is limited to student observations from 1996-2005, grades 9 through 12 (4,263 observations), using a repeated-measures, cross-sectional model. A significant upward trend revealed the odds of being overweight to be 1.43 times greater in 2005 compared to 1996. Rates of overweight and obesity were 23% and 17%, respectively. The greatest prevalence of obesity was among young adolescent non-Caucasian males. The odds of having elevated blood pressure was 6.9 times higher in obese versus normal-weight students. A significant association between overweight and receipt of referral for care was observed. Being overweight was significantly associated with poverty and the low education level of the head of the household. Interventions prior to adolescence are needed to reduce the rate of obesity and cardiovascular complications.