This chapter analyzes the impact of climate change and variability on food security of rural households in the central highlands of Ethiopia taking Basona Werana district as a case study site. Data were obtained from 123 households selected using simple random sampling from three agro ecological zones. Key informant interviews and focus group discussion (FDG) were used to supplement the data obtained from household survey. The monthly rainfall and temperature data are for 56 points of 10 × 10 km grids reconstructed from weather stations and meteorological satellite observations, which cover the period between 1983 and 2016. Standardized rainfall anomaly (SRA), linear regression (LR), and coefficient of variation (CV) are used to examine inter-annual and intra-annual variability of rainfall. Annual and seasonal rainfalls show decreasing trends over the period of observation. The decreasing trends in annual and March–May (Belg) rainfall totals exhibit statically significant decreasing trends at p = 0.05 level. Kiremt (June–September) shows statically significant decreasing trends at p = 0.1 level. Mean annual maximum and minimum temperatures show statically significant increasing trends at p = 0.05 level. More than 80% of households perceived that the climate is changing and their livelihoods (crop and livestock production) are impacted. The district belongs to one of the most vulnerable areas to climate change and variability in the country where large proportions of households (62%) are under different food insecurity classes. Results suggest that local level investigations are useful in developing context-specific climate change adaptation.