Undernutrition rates in Pakistan have remained unchanged for over half a century. Success in tackling under-nutrition relies on cross-sectoral action across health, food, agriculture, poverty, water and sanitation. A recent positive momentum has involved loose inter-sector coalitions in the provinces supported by international development partners. However, weak understanding of nutrition, low ownership, minimal allocations, siloed working of sectors and lack of effective homegrown coalitions constrain meaningful action. Pakistan requires political championing by the executive leadership, central convening structures in the provinces and common policy and monitoring frameworks.