Food security in the Pacific, especially in Micronesia, has worsened in the past half century. Agriculture, fishing and local food production have declined, except in the most remote islands, especially in peri-urban environments. Diets have incorporated more processed and imported foods, because of prestige, accessibility, cost and convenience, at financial, social, environmental and nutritional cost to countries and households. Non-communicable diseases have grown rapidly throughout Micronesia. Household expenditure is dominated by imported foods, especially rice. Food security requires more adequate market access, but national resource bases are limited, and government intervention and policy formation are both weak and exhibit urban bias in unusually fragmented states. Climate change is likely to further hamper local food production. Household has negotiated multiple livelihoods across international boundaries with national and household incomes boosted by remittances, which may become a distinctive key to achieving improved health and nutritional status.