Purpose: Childhood cancer survivors (CCS) are at increased risk of long-term metabolic complications, yet data from low- and middle-income countries are scarce. This study aimed to estimate the prevalence of obesity , central obesity , and dyslipidaemia among CCS in India and to identify clinical predictors of adverse metabolic outcomes. Methods: This was a cross-sectional analysis of CCS enrolled in a structured survivorship program at a publicly funded tertiary cancer centre in North India. Survivors diagnosed at ≤21 years of age and aged ≥5 years at enrolment were included. Anthropometric and lipid parameters were analysed, and multivariable logistic regression was used to identify predictors of metabolic abnormalities. Results: Out of 965 survivors evaluated (median age 16 years; 75.2% male), overweight and obesity were present in 15.9% and 18.2%, respectively , central obesity was observed in 46.1%. Central obesity affected 25.8% pediatric and 74.4% adult survivors. Among survivors with complete lipid profiles (n=292), dyslipidaemia was detected in 73.6%. Adult survivors had higher odds of overweight/obesity (adjusted odds ratio [aOR] 2.28), central obesity (aOR 8.7), and dyslipidaemia (aOR 2.62) compared with pediatric survivors. Female survivors were more likely to have central obesity (aOR 1.97) and dyslipidaemia (aOR 2.07). Notably , 31% of survivors with normal or low BMI had central obesity . Conclusion: Metabolic abnormalities were highly prevalent among CCS in India, particularly among adults and females. The marked age-related increase in central obesity highlights the limitations of BMI-based screening. Integration of routine metabolic surveillance into long-term and primary care follow-up may mitigate future cardiometabolic risk.