Changemaker objective: To implement & evaluate a sustainable health intervention program on health, nutrition, & environmental outcomes for the primary prevention of adolescent obesity & related non-communicable diseases (NCDs) together with adolescents in three rapidly urbanizing cities in Burkina Faso, Kenya, Tanzania. Background: There is an increasing epidemic of adolescent obesity that can contribute to adult obesity, morbidity & NCDs in a broader sense. Sustainable health interventions in urban low- and middle-income countries are critical in addressing lifestyle factors that contribute to obesity, diabetes & hypertension in later life, such as unhealthy dietary habits, inactivity & sedentary behaviors while shaping urban environments. Considering obesity is a complex issue that is influenced by wide range of interconnected factors, such as policy, environment, social, economic, cultural, behavioral, commercial, & biological determinants, a whole-systems approach that converges multiple sectors (i.e., health, education, environment, and agriculture) and stakeholders (i.e., adolescents, caregivers, staff, local government, communities, policymakers & implementers) are needed for obesity prevention in LMICs. Our strategy: Four evidence-based strategies, which will be adapted to context through a co-design process: 1) urban farming in schools with satellite farms and organic waste composting, 2) sustainable health modules for classrooms, 3) linking to healthcare workers through health talks using motivational interviewing techniques and 4) WHO Best Buys: Mass media campaign. Our evaluation: 3 cluster-RCTs in secondary schools, within the framework of urban Health & Demographic Surveillance Systems, implementation, process evaluation & cost-effective evaluation. Our expected results: Evidence of how to implement and scale a sustainable health intervention. Estimate a mean difference in BMI of 0.175 which could lead to reduction of 5% in the prevalence of obesity.

Noncommunicable diseases (NCDs) are a major public health problem, resulting in over 70% of global deaths each year; the majority (85%) of deaths occur in low-and middle-income countries. While cost-effective, evidence-based best practices are available, implementation of these interventions has remained a critical challenge, particularly ones targeted at promoting health behaviors among adolescents and youth. Despite the importance, few studies have been undertaken to identify the facilitators and barriers to the implementation of evidence-based interventions that promote healthy behaviors among adolescents and youth in sub-Saharan Africa (SSA). "Reducing nutrition-related noncommunicable diseases in adolescence and youth: From nutrition literacy to fluency" will take a major step towards improving the implementation of evidence-based interventions – nutrition education and SSB policy - that promote healthy behaviors among adolescents and youth in SSA to reduce the impact of NCDs. With the use of a multi-disciplinary approach, innovative design, and cutting-edge tools, the proposed project aims to establish a global alliance to prevent and reduce nutrition-related NCDs among adolescence and youth in SSA region, by shaping individuals’ health behaviors through nutrition literacy and fluency, assessing the impact and performance of the nutrition-related policy and promotion programs, and providing flexible, cost-effective, scalable, reliable, secure and easy-to-use tools. The establishment of an Africa Think Tank for Adolescents and Youth Health, and annual forums will help facilitate continuous engagement with key stakeholders to enhance buy-in, acceptance and relevance of the project outputs. Ultimately, the expected wider effects of this project include improved NCD prevention policy adoption and implementation, improved policies and evidence-informed decision making amongst key stakeholders, and ultimately decreased avoidable mortality due to NCDs.