An essential element of the "health transition" is the emergence of disease patterns associated with changes in dietary regimes. The consumption of nutritionally poor (imported) foods in the Pacific is associated with increasing rates of diet related non-communicable diseases (NCDs). An oft-made assumption is that changes in consumption patterns are related to food preference (specifically preferences for high fat and/or dense carbohydrate foods). Recent work in the Kingdom of Tonga suggests that the "common-sense" association between food preference and food consumption is incorrect. The results of a large survey (n=430) indicate availability is the key factor in consumption, and that food preference, knowledge of the nutritional values of foods, and frequency of consumption are not correlated. Further analysis shows there are significant differences in consumption patterns between persons of higher and lower socio-economic status; perception of availability and frequency of consumption are a function of economic and social position--specifically access to cash. These results underline the salience of economic factors; the rise in NCDs is correlated with the increasing importance of the cash economy (not cultural values or ignorance of nutritional issues). In the absence of economic solutions, current consumption patterns will continue.