||Climate change is set to be particularly disruptive in poor agricultural communities. We assess the factors influencing farmers’ choice of climate change adaptation practices and associated impacts on household food security and poverty in Pakistan using comprehensive data from 950 farmers from its major provinces. A probit model was used to investigate the factors influencing the use of climate-change adaptation practices; the censored least absolute deviation (CLAD) was used to analyze the determinants of the number of adaptation practices used; and a propensity score matching (PSM) approach was employed to evaluate the impact of adaptation practices on food security and poverty levels. Adjustment in sowing time (22% households), use of drought tolerant varieties (15%) and shifting to new crops (25%) were the three major adaptation practices used by farmers in the study area. Results show that younger farmers and farmers with higher levels of education are more likely to use these adaptation practices, as do farmers that are wealthier, farm more land and have joint families. The number of adaptation practices used was found to be positively associated with education, male household heads, land size, household size, extension services, access to credit and wealth. Farmers adopting more adaptation practices had higher food security levels (8–13%) than those who did not, and experienced lower levels of poverty (3–6%). Climate change adaptation practices at farm level can thereby have significant development outcomes in addition to reducing exposure to weather risks.