Pasifika peoples experience disproportionate rates of obesity and diabetes-related conditions that reduce their quality of life and, for many, have resulted in premature death. Unfortunately, Pasifika peoples affected by these preventable life-style diseases have increased in numbers and lowered in age. A set of complex factors appears to influence the health choices of Pasifika peoples, and these need to be better understood. Therefore, this study had three aims: (a) to explore the perspectives of Pasifika peoples from three generations to understand what health means to them, (b) to understand how and why these perspectives influence their health choices, and (c) to identify a response that ensures healthier lives and greater longevity in Pasifika communities. Constructivist grounded theory, Talanoa, and Tongan fala weaving were combined as the methodological approach informing the enquiry involving 29 participants residing in Southeast Queensland. This included individual talanoa with 12 elders representing various Pasifika ethnicities. Gender and age-specific group talanoa also engaged parents and teenagers from one Pasifika church, who were predominantly Samoan. A total of five families participated. The study identified conflicting perspectives regarding the definition of the term “health”, which elders and some parents perceived as a western term focusing specifically on the body and devoid of spirituality. Their preferred term was “wellness”. Factors influencing participants’ health choices included their Christian faith, their commitment to family, their beliefs regarding food, and their quest for prosperity. Strong Pasifika cultural beliefs shaped each factor. Findings informed the development of the Dominant Pasifika Perspectives of Wellness model, which visually captures the interaction of factors influencing health choices. A further finding was that some participants had actively challenged behaviours associated with the dominant Pasifika perspectives of wellness. In doing this, they reported that they had improved their wellness and quality of life. The process they adopted is presented visually in the Alternative Pasifika Perspectives of Wellness model. Both models have utility for informing policy and practical responses to the prevention and management of obesity and diabetes-related conditions within Pasifika communities.