BMC Public Health 2009, 9:485 http://www.biomedcentral.com/1471-2458/9/485 tion in wealth, was based on reports of current economic hardships and financial coping mechanisms. The weak correlation between STL and the present household eco- nomic situation index (0.42) suggests that they reflect dif- ferent aspects of family affluence. Affluence and urban lifestyle are associated with a higher prevalence of overweight in lower and middle income developing countries [7]. This was the case in this study where adolescents in Ramallah governorate had a higher prevalence of overweight/obesity than in Hebron; proba- bly due to higher standards of living [14]. Adolescents in Ramallah had better indicators of economic situation such as STL index and the present household economic situation index. They also had better social indicators such as smaller family size. Furthermore, the prevalence of overweight/obesity was higher in urban areas and among those with high STL and this was more pronounced among boys. Similar associations of overweight among boys with high family affluence scale were found in the Palestinian HBSC study [12]. Overweight/obesity was higher among girls than boys. In Palestine, boys are reported to be more physically active than girls [25]. Cultural restrictions on girls imply that they spend more time indoors and thus have easier access to food. These findings are similar to those found in a 2002 North Gaza Strip study, in which 15.4% of the boys and 20.2% of the girls aged 12-15 years were found to be overweight/obese (using the 2000 CDC reference) based on measured weights and heights [16]. However, the validity of this comparison may be questionable now as the economic situation has deteriorated considerably in Gaza since 2002 [20]. An opposite trend in gender differ- ence was found in the Palestinian HBSC survey conducted among adolescents aged 12-18 years in 2003/2004 in the West Bank and the Gaza Strip. This survey reported over- weight/obesity (using IOTF criteria) of 20.4% among boys and 13.0% among girls [12], while in our study the corresponding percentages by the same criteria were higher in girls (22.2% in Ramallah and 16.9% in Hebron) than in boys (18.5% in Ramallah and 13.1% in Hebron). One explanation might be that the Palestinian HBSC study used self-reported weights and heights. Self- reported data tend to underestimate overweight preva- lence, especially among girls [26]. Moreover, the age groups were different between the HBSC study and our study, and the sample in our study was selected from only two governorates in the West Bank while the HBSC study was a national-level study in the West Bank and the Gaza Strip. In the Palestinian HBSC study, 27.5% of the data was missing for BMI. In contrast, there was no missing data in our study. A 2003-2004 national survey of Jewish and non-Jewish Israeli school adolescents (aged 11-19 years) found that among boys, the prevalence of overweight/obesity (using the 2000 CDC reference), based on measured heights and weights, was 19.6% for Jews and 22.6% for non-Jews (mostly Arabs and Druze) while in girls it was 15.7% for Jews and 20.3% for non-Jews [27]. Also in this case, the gender difference was opposite to the findings in our study. Such a comparison should also be taken with cau- tion because of a much wider age range and sampling frame in this study compared to our more limited study. In Lebanon, boys in private schools (aged 12.5-15 years) in 2002-2003 were found to have higher rates of over- weight and obesity than girls using measured weights and heights. The prevalence of overweight and obesity (using IOTF criteria) among boys was 29.2% and 8.7%, respec- tively. The corresponding figures for girls were 18.7% and 3.7%, respectively. Western feminine self-image and fears of obesity were more marked among Lebanese girls than boys [28]. Studies in the Gulf areas, enjoying higher standards of liv- ing than the West Bank, showed a higher prevalence of overweight/obesity than our figures. Some of these studies showed higher prevalence of overweight/obesity among boys and other studies showed higher prevalence among girls. A study in 2003-2004 among Qatari adolescents aged 12-17 years found a prevalence of overweight and obesity based on measured weights and heights (using IOTF criteria) of 28.6% and 7.9% among boys, respec- tively and 18.9% and 4.7% among girls, respectively [29]. In contrast, studies in 2000 in Bahrain among adolescents aged 12-17 years found a higher rate of overweight and obesity among girls based on measured weights and heights. The prevalence of overweight and obesity among boys (using IOTF criteria) were 15.3% and 14.9%, respec- tively while the corresponding figures for girls were 24.5% and 17.9%, respectively [30]. As reported in other studies [22], overweight/obesity was associated with family size. The mean family size in the West Bank is 5.5 [11]; however, it was larger in our study (8.1 in Ramallah and 8.9 in Hebron) as the sample repre- sents a selected segment of families that have progressed further into their life cycle. The prevalence rates of underweight were lower in Ramal- lah than in Hebron. Multivariate regression analysis showed that underweight was negatively associated with residence in Ramallah among girls and with high STL among boys. Stunting rates were similar in both governo- rates. Both underweight and stunting were higher among boys than among girls in both governorates. The same pattern between boys and girls of higher underweight (7.0% versus 3.8%) and higher stunting (13.7% versus 6.2%) among boys was reported in the 2002 Gaza study [16]. Similar patterns of higher underweight [29] and higher stunting among boys [31,32] have been also found Page 10 of 12 (page number not for citation purposes)