After two decades of failed efforts to launch a national nutrition programme and nutrition action largely limited to low coverage interventions, a promising multisectoral nutrition scenario is unfolding in Pakistan led by provincial and regional officials and a well‐coordinated group of development partners. The process has emerged from the confluence of three recent events in the country: the floods of 2010 and 2011; the passing of a constitutional amendment in 2010 which had the effect of dissolving the federal government's Ministry of Health and devolving responsibilities for health and nutrition to the provinces and regions; and a National Nutrition Survey in 2011 with results indicating that chronic malnutrition in the country had actually deteriorated over the previous decade. This article discusses the paths leading from these events to the present opportunities to address malnutrition aggressively and systematically, examines the sensitisation, advocacy and strategy development processes employed, and presents both the potential promise and the risks involved in the new provincial and regional nutrition undertakings.