West Africa has experienced very little progress in reducing food insecurity and child malnutrition in the past 20 years. Approximately, one third of children under five years of age are stunted, and 5-15 percent is wasted. Micronutrient deficiencies, particularly lack of vitamin A, iron and iodine, affect mainly women and children and contribute to some of the highest rates of child mortality in the world. Overweight and obesity are emerging problems in some urban populations with negative implications for chronic non-communicable diseases. The causes of malnutrition and food insecurity are complex and include the agro-ecological, socio-economic and demographic characteristics of the sub-region. Rising incomes, rapid population growth especially in urban areas, desertification, as well as HIV/AIDS affect the food system. Changes in diets and lifestyles especially in urban settings involve a shift from the consumption of traditional staples to imported cereals (wheat and rice). Although food availability has generally improved in the subregion, the dietary energy and protein supplies are still below requirements and unstable, especially in Sahelian countries. The nutritional quality of local diets remains low for most people and access to adequate food is not always secure for the poor. Besides the need to diversify and increase food production and productivity, increased support is needed for appropriate food storage, processing, and preservation techniques at community and industrial level, and better distribution and marketing. Technologies, such as fortification and plant breeding, are increasingly relevant within a comprehensive food-based strategy. Nutrition education is a complementary activity for ensuring the effectiveness of food-based approaches. Based on a review of lessons learned from food-based interventions implemented by FAO and other development partners, this paper addresses some of the major issues, challenges and opportunities involved in fulfilling the pledge of West African countries to meet the goal of reducing malnutrition by 50 percent by 2015.