Background: Childhood obesity is considered a serious public health problem and it has increased over the last two decades. The aim of this paper was to report 5-year change in prevalence of overweight and obesity among preschool children in a rural area of Sweden. Material and Method: Body height and weight were obtained in 2004, 2006 and 2008. A total of 1914 children (1014 boys and 900 girls), aged 4 years ± 4 months and were examined at Child Welfare Clinics in two municipalities in the Skaraborg area in Region of Västra Götaland, Sweden were included in the study. Body mass index (BMI) was calculated and categorized according to the International Obesity Task Force (IOTF) and WHO cut-off as reference methods in defining overweight and obesity, and GLM methods were used to estimate the change with age as a covariate. Result: Between 2004 and 2008, overweight increased in boys according to IOTF 2.0% (P = 0.048), whereas no such trend was seen when using WHO cut-offs. In girls, overweight increased significant according to the both definitions IOTF 9.1% (P < 0.001) and WHO 2.8% (P = 0.010). Obesity has decreased in both boys and girls, however not significant. According to IOTF obesity decreased with 1.1% in boys and 1.9% in girls, and WHO with 2.1% in boys and 1.5% in girls. Conclusion: This study shows that overweight has increased in both sexes and obesity rates remained rather steady. However, public health strategies targeting the whole population is still needed.