Background: Childhood obesity has become a pressing global public health issue, particularly in low- and middle-income countries like India. This systematic review aims to investigate the prevalence of childhood obesity and its associated risk factors in urban and rural regions of India. Methods: A comprehensive systematic search was conducted in PubMed, Embase, and Scopus databases to identify relevant English-language studies published within the past decade. Inclusion criteria included studies conducted in India, focusing on children and adolescents aged 0-18, and reporting either the prevalence of childhood obesity or related risk factors. Ten studies, comprising both cross-sectional and quantitative research designs, met these criteria. Results: The findings reveal a significant disparity in childhood obesity prevalence between urban and rural areas of India. Urban regions exhibit notably higher rates, with a pooled prevalence estimated at 9.0% (95% CI: 2.0 to 17), compared to 4.0% (95% CI: 4.0 to 5.0) in rural areas. Risk factors associated with childhood obesity in urban settings include unhealthy dietary habits, limited physical activity, higher income levels, parental education, and attendance at private schools. In rural areas, gender, age, and household size emerged as potential risk factors. Discussion: These findings underscore the urgent need for geographically tailored interventions to address the urban-rural disparities in childhood obesity. Lifestyle-oriented strategies promoting healthier dietary patterns and increased physical activity are essential. Gender-inclusive programs targeting both boys and girls are crucial. Future research should consider regional and cultural diversity to design more effective public health responses. Conclusion: This systematic review provides valuable insights into the prevalence and risk factors of childhood obesity in India. It highlights the necessity for customized interventions and lifestyle adjustments to combat this escalating public health challenge and reduce disparities in health outcomes.