Preventing Childhood Obesity Across Six Cities
Childhood obesity is rising globally, with one in five children now living with overweight or obesity. This has serious long-term consequences. Children who experience obesity are more likely to develop noncommunicable diseases (NCDs) such as diabetes and heart disease, and many continue to face these risks into adulthood. The earlier obesity begins—and the longer it persists—the greater the lifetime health risks.
The challenge is more acute in disadvantaged urban communities. Limited access to affordable healthy food, fewer safe spaces for physical activity, and inconsistent support systems make it harder for children to build and sustain healthy habits. These conditions are often shaped by broader social and economic factors, requiring coordinated action across sectors.
Cities are well placed to respond, but many struggle to move from intention to sustained delivery. Efforts are often fragmented, with unclear roles, limited alignment across stakeholders, and insufficient use of data to guide decisions. As a result, even where there is strong commitment, progress can be slow and difficult to sustain. Recognizing this,Novo Nordisk’s broader Cities for Better Health program focuses on cities as critical sites for prevention, engaging city leadership and communities to drive place-based solutions, with CBH-COPI providing more intensive support to deliver locally tailored, evidence-based interventions and generate robust evidence on what works.
The six cities involved in CBH-COPI were all committed to improving children’s health. Each faced different contexts and barriers but shared common system challenges in translating existing strategies into coordinated, practical action that delivers measurable change.
Starting in April 2024, DA worked alongside city partners to enable a more structured, delivery-focused approach to childhood obesity prevention. In each city, a dedicated delivery lead was embedded locally, working closely with governments, schools, academic institutions, and community organizations.
The focus was on helping cities move from planning to execution. This began by aligning partners around a shared understanding of the problem, grounded in local data and context. From there, DA supported cities in defining clear priorities and establishing roles and responsibilities across the coalition.
Rather than relying on informal coordination, DA helped cities establish clear delivery structures and ways of working. Senior leaders provided direction and removed barriers. Dedicated teams translated priorities into actionable plans with defined ownership. A broader group of partners contributed expertise and helped sustain momentum.
To support execution, DA introduced practical performance management tools and routines—including regular check-ins to review data, identify bottlenecks, and resolve challenges. This enabled cities to stay focused on delivery, adapt in real time, and maintain momentum.
Rather than applying a single model, each city developed a tailored portfolio of interventions shaped by local needs and existing systems—ensuring solutions were relevant, practical, and positioned for long-term sustainability.
In Soweto, Johannesburg, children face a complex reality. Undernutrition and micronutrient deficiencies exist alongside rising rates of obesity. Families navigate food insecurity, limited access to healthy options, and few opportunities for physical activity.
To respond, DA and partners first convened stakeholders across health, education, and nutrition—many of whom became part of the local steering committee. By connecting CBH-COPI to existing city and provincial priorities, the group clarified roles, strengthened accountability, and established the governance needed to move into delivery.
This early alignment led to a shared vision. The focus was not only on improving children’s immediate environments, but also on building the systems needed to sustain progress over time.
Clear roles were then established across delivery, advisory, and evaluation partners. Sportstec leads physical activity delivery, while HEALA supports nutrition implementation. Technical expertise is provided by the Durban University of Technology, and the University of the Witwatersrand leads monitoring and evaluation to ensure consistent tracking of progress.
22 schools across Soweto have been onboarded, creating a strong foundation to begin implementation and generate evidence on what works in this context.
To support long-term ownership, the City of Johannesburg and key government partners, including Gauteng Department of Health and Gauteng Department of Education, will lead regular reviews to track progress, address challenges, and guide the next phase of implementation.
CBH-COPI has moved from concept to coordinated delivery across six cities—establishing early proof points while building the systems required for long-term, scalable impact.
- Cities have established functioning cross-sector coalitions:
Partners across government, education, and community organizations are now working together through clear structures, defined roles, and shared priorities. - Local capacity has been strengthened to deliver and sustain interventions:
Cities now have dedicated teams and local partners, clearer accountability, and practical routines to support ongoing implementation. - A foundation for data-driven learning is in place:
Monitoring systems are being used to track progress, generate evidence, and inform future scale. - Johannesburg, South Africa is strengthening school-based nutrition and physical activity:
22 schools in Soweto are now part of a coordinated approach, with improved school meals, wellness interventions, and systems in place to track outcomes and build evidence. - Mississauga, Canada is embedding healthy habits into the school day:
Schools are introducing daily physical activity and strengthening nutrition programs, with strong community buy-in and early changes in how students eat and move throughout the day. - Campinas, Brazil is integrating prevention into city systems:
The initiative is embedded within an existing municipal program, reaching around 1,000 children and creating a clear pathway to scale through government adoption. - Chiba City, Japan is reinforcing healthy behaviors across daily environments:
Interventions across schools, homes, and community spaces are driving early behavior change, with over 40 families actively using tools to build healthier routines. - Madrid, Spain is expanding school-based prevention efforts:
Initial rollout across four schools is increasing opportunities for active play and supporting healthier choices during the school day. - Logan, Australia is working with diverse community groups to co-design solutions:
This process ensures interventions are culturally relevant, reflect local needs, and can be embedded into families’ daily lives, strengthening uptake and long-term sustainability.
Learn more about the Cities for Better Health Initiative and its global impact: https://www.citiesforbetterhealth.com/
