UN Sustainable Development Goal (SDG) 2: Zero Hunger links ending hunger to achieving food security, improving nutrition, and promoting sustainable agriculture. The Pacific Island Countries and Territories (PICTs) is a region where such linkages can be investigated as the PICTs are confronting climate change while facing a decrease in available arable land and increasing rates of urbanisation. Around 80% of all Pacific Islanders still rely on agricultural produce from their own gardens or from small holder farmers to support or to supplement their diets. The Food and Agriculture Organisation (FAO) has declared the years 2019–2028 to be the Decade of Family Farming. Food imports are increasingly common in PICTs, and can provide cheap, although not particularly nutritious foods, leading to generalised health problems. Increased reliance on imports is itself an indicator of diminishing food security, and with the PICTs facing a range of food security challenges, it is timely to assess the existing literature in the PICTs on the relationship between smallholder farming and food security. This scoping review analyses 49 peer reviewed and grey literature studies in English from 1970–2019 concerning the relationship between food security and small holder farming in the PICTs. It identifies four main themes: (1) Community adaptation, resilience and crop diversification; (2) Decreased availability of local foods and land; (3) Changes in diet; (4) Gender and agricultural production. The review shows Pacific peoples quickly adapt to changing circumstances to plant different crops both for food and for sale, and it identifies the role of small holder agriculture as crucial to: (1) growing local foods to support food security, and (2) expanding domestic asset creation to promote economic development, especially for women.