The unsustainability of food systems is a global policy challenge. There is an urgent need for the improved coordination and integration of policies across sectors to improve food system outcomes. The aim of this study was to examine the role and opportunities for regional governance in strengthening policy for food system transformations, using the Pacific Island region as a case study. We conducted a qualitative policy analysis, drawing on data from 21 interviews with experts and participants in Pacific Island regional food system governance, and the analysis of 17 key regional commitments (policy documents) relating to food systems. The findings indicate that the Pacific Island region has made significant progress towards improved regional food systems governance. Regional governance has been used to address multiple shared and inter-related challenges associated with food systems, improve coordination across silos, and facilitate constructive engagement on policy issues between international, regional, and national actors. However, food systems outcomes related to the economy, nutrition, and environment continue to be mixed, and there are challenges to policy coordination and effectiveness at the regional level. Interviewees envisaged a regional approach characterized by being rooted in regional values, meeting multiple objectives, balancing tensions, and providing meaningful support and resources for countries. Following food systems disruptions associated with the COVID-19 pandemic, this study suggests that there is an opportunity to strengthen regional food system governance through paradigm change, the development of new modes of coordination, and increasing the dynamic interactions between regional institutions, countries, and communities.