ObjectivesTo determine the prevalence of childhood overweight, obesity and metabolic abnormalities among children aged 12-15 years within the schools in Kandy Municipality area, Sri Lanka. DesignCross- sectional observational study.SettingRandomly selected schools in Kandy municipality areaMethodsThe anthropometric measurements of 1766 school children were taken and those who were overweight or obese were recruited for further evaluation of metabolic abnormalities.ResultsThere were 1053 (59.62%) boys and 713 (40.37%) girls of whom 258 (14.60%) were overweight or obese (7.81% overweight and 6.79% obese). This included 106 girls of whom, 64 were overweight and 42 were obese and 152 boys of whom, 74 and 78 were overweight and obese respectively. Central obesity was seen in 16.93% and 5.01% of them had normal body mass index. Eighty-five children out of the 258 with body mass index > 85th percentile reported for further evaluation and the prevalence of metabolic syndrome among them was 11.67% (5 girls and 5 boys). When borderline and abnormal levels of lipids were taken together, more than 50% of overweight and obese children were found to have dyslipidaemia. Elevated Alanine Amino Transaminase and Aspartate Amino Transaminase levels were reported in 33 (38.82%) and 7 (8.24%) respectively. Evidence of fatty liver was present in 34.69% based on abdominal ultra sound scan findings.ConclusionWhile prevalence rates of overweight, obesity and metabolic syndrome are comparable with other urban settings in the country as well as neighbouring countries in Asia, the study highlights the detection of lipid abnormalities suggestive of familial hyperlipidaemia which warrants further evaluation. NAFLD is also identified as a significant comorbidity. Central obesity is underestimated by British standards.