As obesity rates continue to rise in the United States, researchers have pointed toward numerous causes: ultra-processed foods, lack of physical activity, and genetics, among others. Interventions to reduce weight have been well-discussed by public health officials and physicians. Yet years of counseling on increasing physical activity and changing dietary habits has not had the desired impact on population obesity rates. 

 The issue of weight has often been frustrating for physicians and patients alike. Despite the multifactorial causes of obesity, physicians often place blame on patients for failing to lose weight, labeling patients as lazy or noncompliant. Physician stereotypes about patients with obesity both contribute to weight stigma and miss the bigger picture of how structural forces shape patients’ ability to follow medical advice.  

In some areas of Boston, Massachusetts, there are few grocery stores available, and a lack of convenient public transit compounds the problem. Many families are unable to afford the foods that health care providers tell them are healthy options. In fact, over 45% of adults in Suffolk County experienced food insecurity in 2023.  

Over the last year, I have had the privilege of volunteering with Fresh Truck, a community-based organization working to reduce disparities in access to fresh produce in the Boston area. The existence of food deserts is rooted in complex histories of redlining, segregation, and racism, but Fresh Truck’s solution is simple: bring produce to the neighborhoods with less access to healthy foods. Fresh Truck sets up weekly market locations where fruits and vegetables are sold at wholesale prices. The organization participates in the Healthy Incentives Program (HIP), which gives individuals enrolled in the Supplemental Nutrition Assistance Program (SNAP) up to $20 back per month when purchases are made at farmers’ markets.  

The value of nutritional programs that make healthy food accessible to communities is clear. Food insecurity has been repeatedly shown to be associated with obesity, in a phenomenon termed the food insecurity-obesity paradox. Programs like Fresh Truck are a direct effort to both improve food security through access to affordable foods and to promote healthy food choices. In addition, mobile market programs have been shown to increase vegetable intake and decrease rates of food insecurity. These programs are hugely impactful: in 2024, Fresh Truck served 69,099 households and distributed $2,554,471 worth of fresh produce.  

In my time with the mobile market, helping customers through the check-out line and bagging groceries, I have realized that the value of these programs also lies in a form of trust and community-building that is much harder to quantify. Whenever the giant green produce truck pulls up to a neighborhood, there is a line of people waiting outside, regardless of the inconsistent Boston weather. On sunny days, people will bring beach chairs and set up shop in a patch of grass, often returning after they put their groceries away just to catch up with neighbors.  

The Fresh Truck markets are lively, and seeing community members come together week after week is a beautiful demonstration of the confidence that has been built. Everyone knows the truck will come back, and everyone knows that they can lean on their neighbors when they need help. I have watched people pick up groceries for others if their SNAP balance was low, shop for each other, carry someone’s heavy bags, and take the time to explain confusing HIP rules to newcomers.  There is a sense of implicit faith and genuine community that is difficult to find in other places, all centered around this truck.  

Selfishly, it has also been a wonderful reminder that there is room for real change. When the challenges of food insecurity and obesity are discussed in abstract, academic terms, the scale of the problem often makes them feel intractable. Yet going into a neighborhood, watching community members share snacks and catch up with each other, and seeing what interventions like the Fresh Truck look like in practice, all introduce a sense of hope. 

In primary care clinics, nutritional counseling and screening for food insecurity are important steps. However, community-based organizations are what make it possible for patients to follow the guidelines that their health care teams provide and create resources that people genuinely want to come back to. These organizations are doing meaningful work, and it is incredibly important for health systems to help connect patients to these resources. Nutrition counseling ought to extend beyond education – there is great value in providers familiarizing themselves with local organizations working in their patients’ neighborhoods and being able to provide practical guidance for how best to access fresh food. Resources such as the Food is Medicine Massachusetts Service Inventory provide detailed information about nutrition services in the region.   

Next steps

Fresh Truck relies on the help of about 60 volunteers per week. Readers in the Boston area who want to get involved can sign up at freshtruck.org.     

This article was published as part of a series for Obesity for World Obesity Day, March 4, 2025. View the full Special Series for more articles and messages from the editors regarding language and content.

Special Series

About the author

Wingel Xue is a medical student at Harvard Medical School. She holds a BS in Molecular and Cellular Biology from Johns Hopkins University. 

**Feature photo was provided by Fresh Truck. 

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