In Tonga as elsewhere, consumption of inexpensive, high calorie, fatty foods are associated with increases in diet-related non-communicable diseases (NCDs). Programs have been designed to educate people about dangers associated with these foods, but if consumption has increased for economic reasons (e.g., price or availability), such programs may have minimal impact, and other policy options are warranted. A quantitative questionnaire study was conducted in Tonga using a broad sample from different areas (n = 430). The survey elicited information on: preferences for, frequency of consumption of, perception of nutritional value of, and (for a subset) the availability of, 36 traditional and imported foods. People prefer traditional foods and accurately perceive these as more nutritious. However, consumption patterns do not coincide with preference or nutritional value. Policy designed to improve NCDs should, therefore, address the general linkage between economic development and detrimental consumption patterns, and promote the availably and cost competitiveness of healthier, traditional foods.