Purpose: To examine the risks for being overweight (Ow) or obese (Ob) in subjects with elevated Periodontal Screening and Recording™ (PSR™) Codes (>= 1) (with smoking as a modifier) in a population of dental school patients located within a region with a high incidence of Ow, Ob, diabetes mellitus (Db), and cardiovascular disease (CVD). Materials and Methods: 1098 patient files were studied and data were grouped by average PSR™ Codes, smoking history, and body mass index (BMI). Data were compared by factorial ANOVA, the Mann-Whitney U test, and chi-square analysis using PSR™ Code as an exposure for BMI, Db, or CVD, with smoking as the effect modifier. Data were then analysed by adjusted multivariate logistic regression to determine the risks for being Ow or Ob. Results: Subjects with an average PSR™ Code >= 1 and a smoking history did not have a significantly increased risk for either Db or CVD. Non-smoking subjects with an average PSR™ Code = 3 had a significantly higher risk for being Ow; those with an average PSR™ Code of 2-4 had a significantly higher risk for being Ob (p 0.05). In contrast, only smokers with an average PSR™ Code = 4 had a significant risk for being either Ow or Ob. Conclusion: Our data suggest that smoking may not directly increase the risk factors for Db or CVD in subjects with an average PSR™ Code > 1 (confirming the 'Smoker's Paradox'), but could be an indirect risk factor for these diseases as a consequence of its effect on body weight. Keywords: cardiovascular disease, diabetes mellitus, obesity, overweight, PSR™ Code, smoking