The concept of food systems is useful to account for activities and stakeholders and their environmental and health impacts across the food supply chain. Cross-sectoral coordination and site-specific implementation can help achieve synergistic outcomes for food, environment and health. However, most policies and interventions are designed in silos, and may have unintended consequences that negate their intended objectives. This study characterises the drivers, pressures, state and impacts of change in selected food systems across diverse geographies of India and recommends potential response actions. A network of actions and actors is constructed to identify the most impactful actors and actions to achieve sustainable and healthy food system outcomes in India. Public education and awareness, farmer capacity development and streamlining sustainable and healthy diets through social safety net programmes emerge as important pathways with high impact on environment, food and health. The analysis also highlights the importance of local actors in implementing devolved governance of high-level policy and programme interventions.