From salt bans to school gardens, how small cities worldwide are taking on childhood obesity

In fact, cities like Manchester in the UK, Kumasi in Ghana, Cape Town in South Africa, and Ouagadougou in Burkina Faso, have actionable takeaways by tightening vendor regulations, embedding science-backed nutrient standards, integrating local farmer producers into supply chains, and actively shaping the food environment beyond school gates.

The Manchester experiment

Greater Manchester stands out because its policy evolved from on-ground conversations between health officials and communities.

“What worked was shifting the blame from parental decisions to investigating structural factors that shape children’s choices. We found that many families in deprived areas live in ‘food deserts,’ surrounded by cheap fast-food outlets rather than affordable, healthy alternatives. Children are exposed daily to aggressive marketing, from ‘buy one get one free’ offers to energy drinks, making unhealthy food the default choice,” says Jessica Holloway, Strategic Lead, Behaviour Change Public Health, NHS.

She and her team gathered over 10,000 responses for a survey where residents identified interconnected triggers: lack of safe play spaces, excessive screen time, misleading food labels, and the overwhelming presence of junk food.

“We drew attention by using the tactics of junk food marketing, using bold visual props like a giant milkshake to capture attention and spark conversations. Residents, particularly young people, debated causes and solutions among themselves, ultimately leading 79% of respondents to rank childhood obesity as a top public health priority,” says Holloway.

Authorities have introduced 400-metre “buffer zones” around schools to limit children’s exposure during daily commutes. Simultaneously, they acknowledged the economic concerns of small food vendors and nipped any protest in the bud.

“The goal is to replace, not just remove. You have to give a workable alternative. We encouraged them to gradually reduce ultra-processed food, promote locally grown produce and support community gardens to challenge the perception that healthy food is inherently expensive,” says Holloway.

Students conducted observational research, documenting their “social wallpaper” of constant exposure to fast food, sugary drinks, and alcohol advertising across transport networks and neighbourhoods. “They were themselves shocked by the findings and presented them to the mayor. This bottom-up pressure, combined with evidence and public consultation, helped us secure political will and investment in food standards,” adds Holloway.

At the same time, free breakfast clubs in low-income communities are showing tangible benefits in the health indices of children. They are better nourished, more attentive, and ready to learn. A three-year research is now under way to track the long-term impact of these combined policies.

Salt shift in Kumasi, Ghana

Kumasi in Ghana offers one of the clearest examples of how small, targeted regulations can influence population health. Faced with a high burden of hypertension that affects roughly 38% of the population, the Kumasi Metropolitan Assembly banned use of salt shakers in restaurants and local “chop bars” in February.

“A 2025 observational study of 156 food establishments found that 62% routinely placed salt on tables, encouraging excessive consumption. By simply removing this default option, the city is nudging consumers toward lower sodium intake without relying on individual restraint,” says Joseph Ngamije, Deputy Director Africa and Eastern Mediterranean Regions PHC, Vital Strategies.

This intervention extends to the school food environment as well, with authorities monitoring and setting limits on the amount of salt used in school meals. The approach is evidence-based as reducing sodium intake is known to lower blood pressure, improve cardiovascular health, and enhance the effectiveness of medications for hypertension and diabetes. Rather than overhauling entire diets, it focuses on altering everyday behaviour through regulation of the food environment.

Good food movement at Ouagadougou, Burkina Faso

In Ouagadougou, the challenge is less about excess and more about imbalance — school food environments have traditionally relied on limited menus, with widespread availability of snacks and sweets sold around schools. In response, the “Good Food at School” (GF@S) initiative is working to transform how children access and experience food, not just within canteens but across the broader ecosystem.

“By linking school feeding programmes directly with family farmers, the initiative ensures fresher produce while creating stable markets for local agriculture. Equally important is its participatory governance model. Schools are not passive recipients but active decision-making spaces where communities and parents shape menus, vendor practices and nutrition education,” says Homère Sidwayan Ouedraogo, Technical Lead, Partnership for Healthy Cities in Ouagadougou.

Parents as cooks

In Nairobi, the city government has found an innovative urban financing model, where city-level revenues — including parking fees and other local charges — are part of the pool used to subsidise hot, freshly-prepared school meals.

“It is scalable and sustainable because it treats school feeding as a city service, not just a national programme,” says Victor Kibe, County Head Division of Non-Communicable Diseases. “What’s more, the schools use locally cooked meals, often involving parent volunteers and community workers.  Ingredients are sourced locally, and meals are cooked fresh daily — closer to home-style food than processed catering,” he adds.

A similar model is found in Cape Town, where over 50,000 volunteer food handlers, mostly parents, prepare meals within schools, creating a sense of ownership and accountability. School food gardens supplement meals with fresh produce, while nutrition education encourages families to adopt healthier practices at home, moving away from high-starch, low-diversity meals towards more balanced diets.