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Food environments are changing in a rapidly urbanizing Africa. These changes have important dietary consequences in a region already contending with the triple burden of malnutrition. In this article, we first discuss the challenges associated with defining and measuring food environments in low- and middle-income countries and present recent progress in developing context-appropriate indicators and tools. Further, using mixed methods scoping reviews, we examine how urbanizing food environments affect diets and nutrition in Africa, differentiating between various food environment domains, namely food accessibility, affordability, convenience, and desirability. The findings suggest that urbanization improves stable access to more diverse and nutritious foods. At the same time, urbanizing food environments make ultra-processed foods and other convenient but unhealthy food choices more accessible, affordable, and desirable, contributing to overweight, obesity, and chronic disease risk. We discuss several policy options to improve the healthfulness of food environments, including industry and retail regulation, product labeling, taxes and subsidies, and school feeding programs, among others. National and local policy approaches need to be context-specific and considered within the wider political economy of food environments. We also mention further research needs in terms of measuring food environments and evaluating the effects of policy interventions.