Background: Childhood obesity has become a growing global epidemic. In South Africa, overweight and obesity during childhood and adolescence are rising. The objectives of this study were (i) to estimate the prevalence of overweight and obesity among selected students in Cofimvaba, a rural settlement in Eastern Cape province, South Africa, and (ii) to assess the accuracy of the mid-upper arm circumference (MUAC) and ultrasound triceps skin-fold thickness (TSF) methods of predicting these health parameters Methods: A cross-sectional study was conducted on 211 students (109 girls and 102 boys) selected randomly from five public schools in Cofimvaba and aged 6-19 years. The weight, height, MUAC and TSF were determined by standard techniques. Data obtained were subjected to descriptive statistics, Pearson correlations and receiver operating characteristic (ROC) curve analysis. P < 0.05 was considered statistically significant. Result: Overall 1.9% (1.8% girls and 2.0% boys) of the respondents were underweight, 14.8% (21.1% and 7.8% boys) were overweight and 2.8% (4.6% girls and 1.0% boys) were obese. The prevalence of overweight and obesity was significantly higher (p < 0.05) in girls than boys during adolescence but there was no gender difference in children (6-9 years). Most of the students (80.6%) had a healthy weight, with boys being significantly (p < 0.05) healthier than girls. The BMI showed significant strong correlations with MUAC (r = 0.926; p < 0.001) and TSF (r = 0.643; p < 0.001). ROC curve analysis gave an area under the curve (AUC) of 0.795 (95% CI, 0.761-0.889) and 0.835 (95% CI, 0.771-0.899) for MUAC and TSF respectively. Conclusion: The study found a high prevalence of overweight children in the sample and a low prevalence of stunting and underweight. The adolescent girls are at a higher risk of being overweight and obese than the boys. MUAC and TSF can adequately predict overweight and obesity among the selected students.

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