Background: Childhood obesity is a growing global epidemic affecting both children and adults. According to the World Health Organization, 43 million children under five are overweight worldwide, a concern that extends into adulthood with almost 1.5 billion affected individuals. Objective: The aim of this study was to assess the prevalence of overweight, obesity, and underweight among primary school children in district Swat, Pakistan. Methods: This cross-sectional descriptive study was conducted from August 2023 to February 2024, encompassing 707 primary school students selected through multi-cluster sampling. Measurements adhering to CDC guidelines were recorded. Data analysis was performed using SPSS 22, employing descriptive and inferential statistics, including chi-square tests for associations and independent t-tests and ANOVA for group differences. Results: The cohort comprised predominantly male students (88%, 622 students), with the most common age being 11 years (31.8%, 225 students). Overall, 71.9% (508 students) were categorized as healthy, 15.3% (108 students) as overweight, 8.8% (62 students) as underweight, and 4.1% (29 students) as obese. Significant differences were observed across gender (p=0.003), age (p<0.001), and class (p<0.001), but not school type. Conclusion: The study highlights a significant prevalence of overweight and obesity among primary school students in rural Pakistan, emphasizing the urgent need for tailored obesity prevention strategies and interventions in these areas.