Is Traditional Agriculture a Viable Solution for Controlling Obesity and Food Insecurity in the Context of Climate Change? A Case Study from the Federated States of Micronesia

<i>Background:</i> Climate change poses a significant threat to food security in the Federated States of Micronesia (FSM) by disrupting fisheries and global rice supply chains. Rice, an entirely imported staple, dominates local diets and is associated with a high prevalence of non‑communicable diseases (NCDs), particularly obesity and diabetes. Reviving traditional foods such as swamp taro has been proposed as a strategy to improve nutrition, reduce NCDs, and enhance climate resilience. <i>Objectives:</i> This study examines whether traditional agriculture-specifically the promotion of swamp taro flour-can serve as a viable intervention to address obesity and food insecurity in FSM. It aims to identify the social, cultural, institutional, and environmental barriers and enablers influence the sustained uptake of traditional starches. <i>Methods:</i> Using a case study approach focused on Pohnpei, the study applies the Consolidated Framework for Implementation Research. It combines analysis of secondary quantitative data on NCDs, key‑informant interviews, and a review of relevant national and state‑level policy documents to assess the implementation and outcomes of an intervention led by the Island Food Community of Pohnpei. <i>Findings:</i> The uptake of swamp taro flour is shaped by complex interactions among historical preferences for rice, taste and convenience, supply‑chain constraints, gendered labor roles, limited institutional support, and weak community ownership of intervention infrastructure. Despite widespread availability and strong nutritional benefits, swamp taro remains underconsumed, while rice and processed foods continue to dominate diets. <i>Conclusions:</i> Traditional agriculture can contribute to addressing obesity, food insecurity, and climate adaptation in FSM, but only if interventions account for the intertwined social, cultural, economic, and institutional factors shaping food choices. Institutional analysis, community participation, supportive public policy, and culturally sensitive communication are critical to scaling and sustaining such efforts in Pacific Island contexts.