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The objective: To implement and evaluate a sustainable health intervention program on health, nutrition, and environmental outcomes for the primary prevention of adolescent obesity and other 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 and morbidity and NCDs in a broader sense. Sustainable health interventions in urban low- and middle-income countries (LMICs) are critical in addressing lifestyle factors that contribute to obesity, diabetes, and hypertension in later life, such as unhealthy dietary habits, inactivity, and sedentary behaviors while shaping urban environments. Considering obesity is a complex issue that is influenced by a wide range of interconnected factors, such as policy, environment, social, economic, cultural, behavioral, commercial, and biological determinants, a whole-systems approach that converges multiple sectors (i.e., health, education, environment, and agriculture) and stakeholders (i.e., adolescents, guardians, school administration and staff, local government and communities, policymakers and implementers, civil service organizations) 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) World Health Organisation (WHO) Best Buys: Mass media campaign. Our evaluation: Three cluster-RCTs in secondary schools, within the framework of urban Health and Demographic Surveillance Systems, implementation and process evaluation and cost-effective evaluation. Our expected results: Evidence of how to implement and scale a complex sustainable health intervention. Estimate a mean difference in Body Mass Index (BMI) z-score of 0.175 which could lead to a reduction of 5% in the prevalence of obesity. Our team: Multisectoral interdisciplinary team with experience in health sciences, social sciences, behavioral psychology, implementation science, economics and epidemiological methodologies, food science and nutrition and planetary health agriculture sciences from leading African, European and North American institutions.