Objective: To document nutritional status and health behaviours of young indigenous women of childbearing age in rural communities in north Queensland.Design Cross-sectional survey of 424 Aboriginal and 232 Torres Strait Islander (TSI) women aged 15-34 years, conducted in twenty-three rural and remote communities of far north Queensland in 1999-2000, with follow-up of a smaller cohort (n 132) in 2006-2007.Main outcome measures Weight, waist circumference, intake of fruit and vegetables, smoking, alcohol intake, fasting blood glucose, blood pressure, HDL cholesterol, γ-glutamyltransferase, red cell folate (RCF), interval weight and waist gain and incidence of diabetes.Results: Forty-one per cent of Aboriginal and 69% of TSI had central obesity, 62% were smokers, 71% drank alcohol regularly and of those, 60% did so at harmful levels. One third of Aboriginal and 16% of TSI women had very low RCF levels. In the group followed up, there was a mean annual waist gain of 1.6 cm in Aboriginal women and 1.2 cm in TSI, 0.5 kg/m2 in BMI and 1.5 kg in weight. Incidence of new type 2 diabetes mellitus in this cohort was 29.1 per 1000 person-years (py) (95 % CI 14.0, 52.8) in Aboriginal women and 13.9 per 1000 py (95% CI 5.6, 28.5) among TSI.Conclusions: High prevalence and incidence of central obesity and diabetes, poor nutrition, high rates of alcohol use and tobacco smoking together with young maternal age, provide a poor intra-uterine environment for many indigenous Australian babies, and contribute to high perinatal morbidity and future disability. Community level interventions to improve pre-pregnancy nutrition and health behaviours in young women are urgent.