Abstract. Full text article available at https://doi.org/10.1111/tmi.13330The objective of this study was to evaluate gender differences in nutritional status, dietary intake, physical activity and hand hygiene among adolescents from diverse geographical settings in sub‐Saharan Africa.This study utilised cross‐sectional data from six countries (Burkina Faso, Ethiopia, Ghana, Nigeria, Tanzania and Uganda) within the ARISE Adolescent Health Survey (n = 7625). Body mass index (BMI) was calculated using measured heights and weights, and z‐scores were calculated based on the 2007 WHO growth standards for age and sex. Information on demographics, diet and health behaviours was collected through face‐to‐face interviews using a standardised questionnaire. Site‐specific and pooled prevalence ratios were determined. The prevalence of underweight, overweight and stunting pooled across sites was 14.3%, 6.8% and 18.1%, respectively. Female sex was associated with a lower risk of being underweight (pooled prevalence ratio 0.66, 95% 0.57, 0.77) and stunted (pooled PR 0.63, 95% CI 0.55, 0.71), but a higher risk of being overweight (pooled PR 1.60, 95% CI 1.26, 2.06). Females were also less likely to exercise for 1 h or more per day (pooled PR 0.77, 95% CI 0.67, 0.88), and more likely to wash hands after using toilets or latrines and to wash hands with soap (pooled PRs 1.13, 95% CI 1.05, 1.21 and 1.35, 95% CI 1.23, 1.45, respectively).Our results emphasise that sex is a key predictor of nutritional status among sub‐Saharan African adolescents and suggest that gender‐specific interventions may be required to reduce the double burden of under‐ and overnutrition.