Strategies to fight hunger and early warning systems often focus on identifying food crises rather than longer-term trends, and concentrate on rural areas. Data on the food and nutrition security situation of West Africa’s growing urban population is scarce and fragmented. Using geo-referenced information available in the Demographic and Health Surveys (DHS), this report estimates the total number and prevalence of under-nutrition and over-nutrition in West Africa for both urban and rural areas. The analysis reveals that almost 110 million people in West Africa are not receiving the correct nutrition for their needs. Over 58 million people in the region are underweight, 22 million of which live in cities. Another 52 million are either overweight or obese, the large majority of whom are adult urban dwellers. This situation reveals the severity of the “double burden” of under- and over-nutrition. It also calls for greater efforts to identify appropriate metrics to monitor food and nutrition security in urban areas.