Public transport provides an opportunity to incorporate physical activity into journeys, but potential health impacts have not been systematically examined. Literature searches were carried out up to December 2017 using Medline, Embase, Transport Database, Scopus, Cochrane Library, opengrey.eu and Google. We identified longitudinal studies which examined associations between public transport and cardio-metabolic health including: adiposity, type II diabetes, and cardiovascular disease. We assessed study quality using the Newcastle-Ottawa Scale for cohort studies and performed meta-analyses where possible. Ten studies were identified, seven investigating use of public transport and three examining proximity to public transport. Seven studies used individual level data on changes in BMI with objective outcomes measured in six studies. Study follow-up ranged from one to ten years with three studies adjusting for non-transport physical activity. We found a consistent association between public transport use and lower BMI. Meta-analysis of data from five comparable studies found that switching from car to public transport was associated with lower BMI: −0.30 kg/m2 (−0.47, −0.14). Few studies have investigated associations between public transport use and non-adiposity outcomes. These findings suggest that sustainable urban design which promotes public transport use may produce modest reductions in population BMI.