Background <p>The high prevalence of noncommunicable diseases related to lifestyle, diet, and obesity is a global health concern, including in lower-middle income countries. There is increasing evidence that characteristics of the built environment can influence residents’ lifestyle, including physical activity and diet. The aim of this study is to describe the characteristics of the built environment and the lifestyle and nutritional status of residents living in different neighborhoods of Accra, Ghana.</p> Methods <p>A cross-sectional study was conducted in Accra between June and July 2023. Twelve neighborhoods were randomly selected on the basis of high and low values of residential density and socioeconomic status. Sociodemographic, household and neighborhood information was collected using the Neighborhood Environment Walkability Scale (NEWS-A) questionnaire adapted for Africa. Physical activity was assessed by the WHO Global Physical Activity Questionnaire. Differences between variables by neighborhood types were analyzed using Chi square test and Kruskal Wallis test, and pairwise comparisons were performed by Dunn-Bonferroni test.</p> Results <p>A total of 631 adults (median age 34.0 years, female 60.5%) participated in the survey. The built environmental characteristics of the different neighborhood types showed significant differences in all subscales of the NEWS (land use mix, street connectivity, safety for walking and cycling, aesthetics, safety from traffic, safety from crime, personal safety, and stranger danger). Work, transport-related and leisure-time physical activity levels and diet (consumption of fruits and vegetables, sweets, sugar-sweetened beverages, fast food and street food, alcohol) revealed variations between neighborhoods. Differences in nutritional status were inconsistent across neighborhood types.</p> Conclusions <p>This study was the first to examine the associations between environmental characteristics, physical activity, diet and BMI in an urban setting in Ghana. Initial descriptive results revealed significant differences in health behaviors and the characteristics of the built environment between neighborhoods in Accra. The associations between these factors require further analysis.</p>