Aim: There is an inverse relationship between obesity and altitude but urbanization could alter this pattern in major cities. We determined the prevalence of excess weight and abdominal obesity in residents of the Peruvian Andean city of Huancavelica. Materials and methods: A cross-sectional study was carried out on 362 residents of Huancavelica city and we performed a multistage random sampling. We used OMS cut-off points for body mass index in normal weight (<25 kg/m2) or excess weight (≥25 kg/m2). Likewise, we use Latin American cut-off points for abdominal obesity. For women, it was 90 cm, and for men, 94 cm. Results: Prevalence of excess weight according to sex was 62.4% in women and 48.1% in men (p < 0.001). Likewise, we found 59.4% and 31.3% abdominal obesity in women and men, respectively (p < 0.001). The age group with the highest prevalence was 30–59 years. Living in urban areas increased excess weight by 34% and abdominal obesity by 42%, compared to rural regions. Conclusion: The Andean city of Huancavelica presents a significant burden of excess weight and abdominal obesity. The urbanization of Andean cities must consider public policies to face the potential changes in nutrition and physical activity.