The aim of this review is to diagnose the nutrition transition in Sri Lanka with special emphasis on the nutrition profile of the country. The estimates reported in peer-reviewed journal articles and relevant national surveys conducted by the government agencies from 1977 to 2017 were synthesized. The estimates were summarized using tabular analysis, and trends over time were estimated using meta-regression models. The synthesis revealed that a considerably higher proportion of Sri Lankan population suffers from at least one form of malnutrition and the problem of undernutrition and hidden hunger is overlapping with the increasing threat of overnutrition despite the better performance shown by the economy as per various social and health indicators. The results of the meta-regression analysis revealed declining trends in many forms of undernutrition, particularly among females, over time. While the estate sector is more vulnerable to undernutrition among preschool children, the urban sector is more vulnerable to rising level of overnutrition across all age cohorts. The society is on the verge of entering into the fourth stage of nutrition transition, which is characterized by the consumption of energy-dense food, overweight and obesity, and rising non-communicable diseases (NCDs). It is recommended to make food systems more nutritionally sensitive through appropriate research, pricing, trade, food and nutrition policies to promote production and consumption of nutritious and healthy foods.