Obesity prevalences are increasing in industrialized and developing countries. As a pilot for a comparative study of physical activity and weight change, we assessed energy expenditure (EE) in young black South African adults living in an urban informal settlement. Total EE (TEE) was assessed using doubly labeled water, activity EE (AEE) and activity patterns by accelerometry and body composition by isotope dilution. Twenty young women and eight men were enrolled. Over 50% of the women and no men were obese (mean BMI 31.0 and 21.6 kg/m(2), respectively). Women had significantly lower TEE and AEE after adjustment for body size, as well as lower levels of moderate and vigorous activity. Neither TEE nor AEE was associated with BMI or percent body fat, whereas percent time in vigorous activity was modestly negatively associated with adiposity. These data add to the small literature on EE and activity among populations undergoing epidemiologic transitions.