Traditional food systems based on harvest from the local environment are fundamental to the well-being of many communities, but their security is challenged by rapid socio-ecological change. We synthesized literature and data describing how a fundamental form of biodiversity, animal body size, contributes to the security of traditional food systems through relationships with species availability, accessibility, adequacy, and use. We found larger vertebrate species were more available, accessible, and used on a per kilogram basis, particularly for mammals. Conversely, larger species were no more or less adequate from a combined nutritional, health, and cultural perspective. Larger species represented more biomass, and this biomass required less time to harvest, with greater but more variable mean caloric returns over time. Smaller species provided more consistent caloric returns and were harvested during documented shortages of prey. This reliance on species with a range of body sizes is consistent with optimal foraging theory and the evolutionary value of flexibility, and highlights the importance of a biodiverse pool of species for traditional food security in times of change. Our synthesis of published literature and data highlights the many socio-ecological correlates of species size and how these relate to the security of traditional food systems.