Non-communicable diseases (NCDs) accounted for 51% of total deaths in South Africa in 2016. Adolescents demonstrating unfavorable body composition and low levels of physical activity are more susceptible to additional risk factors associated with NCDs. This study aims to compare adolescents at risk and those not at-risk regarding body composition and physical activity in the Eastern Cape, South Africa, utilizing a crosssectional design with a stratified random sample of 257 adolescents aged 10-19 years. Participants were categorized as either "at risk" (displaying one or more metabolic risk factors) or "not at risk" (no risk factors). BMI and body fat percentage were measured, and the International Physical Activity Questionnaire (IPAQ) was employed to indirectly assess their physical activity levels. Data analysis included descriptive statistics, independent samples t-tests, Chi-square tests, and logistic regression. Among the 257 adolescents studied, 131 (50.9%) exhibited one or more metabolic risk factors. The at-risk group displayed a higher mean BMI value (25.49 ± 6.11), while higher mean body fat percentages were observed among female participants (30.80 ± 6.82). Notably, both groups met the minimum physical activity requirements recommended by the World Health Organization. Adolescents with a higher sum of skinfolds (indicative of adiposity) were found to be 1.13 times more likely to develop NCDs. These findings underscore the significance of body fat as a prominent risk factor for NCDs in adolescents. Moreover, the study suggests that physical inactivity may not be a primary risk factor for NCDs among adolescents in the Eastern Cape, South Africa.