Islands in the Mediterranean region are important tourist destinations, but overtourism has led to extensive challenges for island communities, not least due to its negative impact on fragile environments. As a result, attention is shifting towards alternative forms of tourism, such as ecotourism, which embrace sustainability principles. This involves the repositioning of protected areas in terrestrial and marine environments as not solely conservation instruments, but also as venues for ecotourism. Despite their small populations, stakeholder involvement in the management of these sites can be a challenging process which is fraught with conflict. Qualitative interviews with stakeholders were conducted in six islands in the central Mediterranean Region: The Aegadian Archipelago, the Pelagian Islands, and the Island of Pantelleria. Different levels of protection exist with the most peripheral islands allocated the highest level of protection and the most restrictions on tourism activity. Stakeholders fear that this will negatively impact their traditions and their livelihoods, and this has led to strong resistance against MPAs. Recommendations are made as to how genuine stakeholder involvement, better management and a rebalancing of power can lead to more competitive ecotourism destinations and improved well-being of local communities in an era of overtourism. Keywords Ecotourism • Islands • Core-periphery • Stakeholder involvement •