To estimate the prevalence of non-communicable disease (NCD) risk factors in Kerala, a community-based, cross-sectional survey was conducted. In 2016–2017 a multistage, cluster sample of 12012 (aged 18–69 years) participants from all 14 districts of Kerala were studied. The main outcome measures NCD risk factors as stipulated in the WHO's approach to NCD risk factors surveillance were studied. Parameters that were studied included physical activity score, anthropometry, blood pressure (BP), fasting blood glucose (FBG), and morning urine sample to estimate dietary intake of salt. The majority of the participants had more than one NCD risk factor. There was no rural-urban difference in terms of raised BP or raised FBG prevalence in Kerala. The higher rates of NCD risk factors and lower rates of hypertension and diabetes control call for concerted primary and secondary prevention strategies to address the future burden of NCDs.