The aim of this study was to understand the status of household food security in rural areas of west China, and to identify key factors that influence security and the measures that will reduce the numbers of undernourished and poor people. Face-to-face interviews were carried out with random households in six counties in different agricultural areas, resulting in 2,586 household questionnaires involving 9,810 household members. The survey data were then subject to statistical analysis. Household food security was associated with net household income or the ability to obtain food. These were significantly and negatively correlated; the majority of the total household income was used for education, medical care, smoking and personal activities such as weddings and funerals. Household food security was affected mainly by the willingness to purchase and the purchasing power of household members. Recommendations to safeguard household food security in rural areas of China include increasing household incomes and providing education on diet and nutrition.