Research into the genetic factors that regulate food intake is arousing great interest. The polymorphism -1438G>A in the serotonin 2A receptor or 5-hydroxytriptamine (5-HT) type 2A receptor (5-HTR2A) gene has been associated with alterations in food intake such as anorexia and bulimia. However, its association with obesity has not been studied to the same extent. Our aim, therefore, was to estimate the association between the -1438G>A polymorphism and obesity risk and related anthropometric variables in a Spanish Mediterranean population. A case-control study including 303 cases and 606 controls paired by gender and age was undertaken. The association between the -1438G>A polymorphism and obesity and other anthropometric measures was studied. No association with obesity risk was observed. However, when only the obese group was analyzed, it was observed that AA subjects presented a lower body mass index (BMI) than G allele carriers (35.2+/-5.3 kg/m2 vs 37.5+/-7.8 kg/m2; P=0.039). Moreover, significant differences were also obtained in waist perimeter that was lower in AA subjects compared to G allele carriers (105+/-11 cm vs 112+/-17 cm; P=0.011). In conclusion, although the -1438G>A polymorphism is not a relevant marker for obesity risk, this variant may play a role in determining BMI in obese subjects.