Background: The global food system is not delivering affordable, healthy, diverse diets, which are needed to address malnutrition in all its forms for sustainable development. This will require Policy change across the economic sectors that govern food systems, including agriculture, trade, finance, commerce and industry – a goal that has been beset by political challenges. These sectors have been strongly influenced by entrenched Policy agendas and paradigms supported by influential global actors such as the World Bank and International Monetary Fund (IMF). Methods: This study draws on the concept of path dependency to examine how historical economic Policy agendas and paradigms have influenced current food and nutrition Policy and politics in Ghana. Qualitative data were collected through interviews with 29 relevant Policy actors, and documentary data were collected from current policies, academic and grey literature, historical budget statements and World Bank Group Archives (1950-present). Results: Despite increased political priority for nutrition in Ghana, its integration into food Policy remains limited. Food Policy agendas are strongly focused on production, employment and economic returns, and existing market-based incentives do not support a nutrition-sensitive food supply. This Policy focus appears to be rooted in a liberal economic approach to food Policy arising from structural adjustment in the 1980s and trade liberalization in the 1990s, combined with historical experience of ‘ failure’ of food Policy intervention and an entrenched narrowly economic conception of food security. Conclusion: This study suggests that attention to Policy paradigms, in addition to specific points of Policy change, will be essential for improving the outcomes of food systems for nutrition. An historical perspective can provide food and health Policy-makers with insights to foster the revisioning of food Policy to address multiple national Policy objectives, including nutrition.