Background: Food security and nutrition are threatened globally due to climate change. The West African Sahel is particularly vulnerable to climate change given food systems that are highly dependent on rainfall and are currently complicated by significant governance and security challenges. The aim of this article is to propose a One Health framework that considers the complex interconnections within food systems in the Sahel using a systems thinking approach. This framework can serve as a guide for stakeholders and policy makers in the design and implementation of interventions that address the underlying causes of food security and malnutrition. Methods: We collected data using participatory and qualitative approaches across three field sites in the Sahel, two in Senegal and one in Mauritania, in 2023 and 2024. We used interviews, participant observation, and photovoice to collect data. We analyzed the data using inductive thematic analysis. We conducted a literature review to identify the existing One Health and Nutrition frameworks and selected two to serve as guiding frameworks. Results: Informed by data from three Sahelian field sites, we propose a new framework focused on food security and nutrition and, grounded in One Health principles. The framework is guided by a bottom-up approach that prioritizes local perspectives and community-driven insights. The framework has five steps: (1) stakeholder engagement, (2) One Health assessment, (3) prioritization, (4) planning and implementation, and (5) monitoring, evaluation, and research. Conclusion: Sustainability and cultural relevance of the framework depend on early and continuous engagement with both the private sector and community stakeholders. Incorporating local perceptions and attitudes toward culturally significant foods enables the design of interventions that are widely acceptable and minimizes barriers to adoption. Seasonal variations in food availability must also be considered, alongside opportunities to leverage private-sector participation to address these gaps. Building on existing programs can reduce implementation costs and streamline prioritization of nutritional interventions. Finally, integrating academic research into monitoring and evaluation enhances understanding of causal pathways and informs evidence-based strategies to improve nutrition outcomes.