Fishing provides livelihoods and food for millions of people in the Global South yet inland fisheries are under-researched and neglected in food and nutrition policy. This paper goes beyond the rural focus of existing research and examines how urban households may use fishing as a livelihood strategy for coping with food insecurity. Our study in Brazilian Amazonia is based on a random sample of households (n=798) in four remote riverine towns. We quantitatively examine the inter-connections between fishing and food insecurity, and find that fishing is a widespread coping strategy among disadvantaged, food insecure households. Fisher households tend to be highly-dependent on eating fish, and for these households, consuming fish more often is associated with a modest reduction in food insecurity risks. Fishing provides monthly non-monetary income worth ≤USD54 (equivalent to ~12% of mean monetary income), potentially reducing food insecurity risks almost as much as the conditional cash transfer Bolsa Família. We estimate that nearly half a million inhabitants of the region’s remote, riverine urban centres are directly dependent on a household member catching fish, a nutritious and culturally-preferred food. Consequently, small-scale urban fishers must be recognized in policy debates around food and nutrition security and management of natural resources.