**Background:** Adolescence is a critical period of rapid growth and development, second only to infancy, with significant nutritional demands. Ethiopia has experienced rapid economic growth over the past two decades, potentially influencing adolescent diets and nutrition. Despite successes in maternal and child health, adolescents have been a relatively neglected group in nutritional interventions. This systematic review and meta-analysis, conducted under the Transforming Adolescent Lives through Nutrition (TALENT) initiative, aimed to collate evidence on the nutritional status of Ethiopian adolescents and the effectiveness of interventions to inform future policies and programs.
**Methods:** A rigorous three-step search strategy was employed across PubMed, EBSCO/ERIC, and EBSCO/CINAHL for primary studies and national surveys published in English from 2000 to 2020. Inclusion criteria were quantitative studies on adolescents aged 10–19 years in Ethiopia, reporting outcomes on anthropometry, micronutrient status, dietary diversity, food insecurity, or eating disorders. Quality was assessed using the Joanna Briggs Institute (JBI) checklists. Meta-analysis for stunting, thinness, and overweight/obesity was performed using a random-effects model with restricted maximum likelihood (REML) in STATA version 17.
**Key Results:** Seventy-six articles and two national surveys (DHS and National Micronutrient Survey) were included. The pooled prevalence of stunting was 22.4% (95% CI: 18.9, 25.9), thinness 17.7% (95% CI: 14.6, 20.8), and overweight/obesity 10.6% (95% CI: 7.9, 13.3). Stunting prevalence ranged from 4.4% to 53.9% across studies, thinness from 4.9% to 44%, and overweight/obesity from 0.6% to 17%. Stunting and thinness were consistently higher in boys and rural adolescents, while overweight/obesity was higher in girls and urban adolescents. Anemia prevalence ranged from 9% to 33%, with the national survey reporting 14.9% in 12–14-year-olds and 11.8% in 15–19-year-olds. Iodine deficiency affected approximately 40%–52% of adolescents, with 48.9% goiter prevalence in one study. Other frequent micronutrient deficiencies included vitamin D (42%), zinc (38%), folate (14.7%), and vitamin A (6.3% in 12–14-year-olds). Low dietary diversity was highly prevalent, with 85.3% of rural and 58.5% of urban adolescents having inadequate diversity. Food insecurity affected 38%–59.6% of adolescents across studies. Eating disorder prevalence was 8.6%, and unhealthy weight control behaviors were reported in 31% of adolescents in Addis Ababa. Predictors of undernutrition included rural residence, male sex, low maternal education, food insecurity, low dietary diversity, and larger family size. Predictors of overnutrition included female sex, urban residence, private school attendance, higher family wealth, physical inactivity, and sedentary lifestyles.
**Clinical Implications:** Ethiopian adolescents face a substantial double burden of malnutrition, with undernutrition remaining predominant but overnutrition emerging as a significant problem, particularly among girls and urban populations. The high prevalence of multiple micronutrient deficiencies, coupled with low dietary diversity and food insecurity, indicates that adolescents are not meeting their nutritional requirements during a critical growth period. The lack of secular trends over the study period suggests that current policies and programs have been insufficient. Context-relevant, multi-sectoral interventions are urgently needed, including targeted supplementation (iron, folic acid, iodine), promotion of dietary diversity, school-based nutrition programs, and strategies to address both undernutrition and the rising trend of overweight/obesity. Interventions must be tailored by sex and setting, and should actively involve adolescents in their design and implementation to be effective.