Childhood stunting remains a prominent metric in the health and development of modern India. In Karnataka, India, districts vary substantially in stunting prevalence. Here we take a close look at the nature of childhood stunting in the state: its epidemiology, genetics, biology, nutritional basis, environmental contribution, policy and field-based understanding. We explore how these factors interact with one another, and suggest ways to target modifiable risk factors for stunting (e.g. nutrition, exposure to infectious diseases, sanitation), which may influence the impact of non-modifiable risk factors (e.g. congenital factors, climate). We suggest that programmes designed to reduce stunting prevalence should accommodate these complex interactions, which could translate to more substantial impact on child health outcomes.