This research focuses on the food, farming and health experiences of two secondary cities of Uganda (Mbale and Mbarara), comparing findings with studies of primary African cities. We draw from survey data, focus groups with healthcare professionals, and in-depth interviews with varied residents. A feminist geographic perspective explored intersections of food, farming and health with varied aspects of identity, and with place (city itself, but also with rural areas). By comparing our secondary city findings to findings from primary African cities this paper sheds light on whether and how food systems in secondary African cities are transforming, and how urban life at this scale is being experienced. Our analysis suggests a good deal of similarity of food insecurity, dietary diversity, and of non-communicable disease experiences and understandings. The main difference was around the food access strategies, the access to land, and the engagement with agriculture and interaction with the rural. How this might change as these secondary cities grow further is not clear but there should not be an assumption that primary city experiences will inevitably be followed. Our findings offer important insights for future research and for those planning for Ugandan and potentially other African secondary city futures. In comparison to primary SSA cities our findings suggest less advance along theorised nutritional transitions (greater hybridity), a higher relevance of the rural for viable urban lives, yet comparable experience of non-communicable disease. This is intriguing, has implications for theory, and warrants further research.