Obesity and the metabolic syndrome (MetS) are challenging public health issues as globesity popularizes. The present study illustrates the trend of obesity and MetS for the last 12 years in Taiwan based on the analysis of Nutrition and Health Survey in Taiwan. Between the two surveys, a large growth on MetS prevalence was observed, from 13.6% to 25.5%. In NAHSIT 2005-2008, the prevalence of MetS in females exceeded that of males in people older than the age of 45. With regard to regional differences, the growing prevalence of obesity and the metabolic syndromes alleviated in the northern area level one, the most urbanized and dense area. Prevalence of obesity and MetS in Hakka, central, and southern areas increased rapidly. Aboriginal areas had the highest prevalence, which increased modestly. Prevalence of MetS rose fast among males, but much slower among females. Comparing the Taiwanese data with other countries, obesity prevalence in Taiwan was higher than in many of Asian countries, but less than in the West. The prevalence of MetS in Taiwanese females reached levels close to that of the West. Reduced rank regression analysis was used to extract a risk reducing dietary pattern in women, featured by not only more vegetables, fruit, lean meat, and fish, but also some specific Taiwanese dietary items including mushrooms, seaweed, and soybean. No apparent increase in intake of certain healthy foods including lean meat, milk, dark-green vegetables, and fruit in the last 12 years, challenges future strategies to promote health.