California's Central Valley produces many of the fruits and vegetables consumed in America. It is also one of the poorest areas of the country. There are high rates of malnutrition and obesity, and residents have little access to fresh produce themselves.

Environmental conditions such as a lack of sidewalks and streetlights, and packs of wild dogs that keep parents from letting their children go outside to play, discourage exercise and healthy living. Constant gang violence and drugs hamper the efforts of anyone hoping to improve things, but there are some who are trying.

Fast-Food Culture

Yesenia Ayala, 20, works at Food Link, a program in Kettleman City that gives free fruits and vegetables to the community.

She says the program starts handing out food at 11 a.m., but people start lining up at 8.

"Kettleman was real rich for its oil," says Ayala, who was raised in the city, which is about halfway between Los Angeles and Sacramento. "Its oil wells were going to bring a lot of people, but it never happened. We are a rural community surrounded by fields and crops."

The city of 2,500 has almost no sidewalks, no streetlights and barely a stop sign.

"We don't have grocery stores, which is very hard," Ayala says. "We have to drive 35 miles in order to get to our nearest grocery store."

Kettleman City is on Interstate 5, the north-south corridor straight through the heart of California's Central Valley. The Kettleman City exit is a fast-food mecca.

"Most of the youth in Kettleman work here in the fast-food restaurants," says Ayala, who worked at a Taco Bell in high school. "When I was working out there, I was overweight. We would get our break and we would go eat at Jack in the Box. You see them before they start working in the fast-food restaurant — how slim — and then you see them working up there and you say, 'Whoa, what happened to her?' "

An 'Obesogenic' Environment

Genoveva Islas-Hooker, the daughter of farm workers in Delano, was raised working in the fields herself. She is now the regional program coordinator at the Central California Regional Obesity Prevention Program in Fresno. The program looks at obesity from an environmental and policy standpoint.

Central Valley has been described as the new Appalachia. It includes some of the poorest congressional districts with some of the worst health disparities in California.

"Poor communities do not have the infrastructure that supports active lifestyles," Islas-Hooker says. "We don't have sidewalks, we don't have streetlights. There are packs of dogs," which causes many people to stay inside.

"We don't have access to stores, to healthy produce," she says. "We've created this very obesogenic environment, and we question why so many people are obese and overweight and at risk for type 2 diabetes — well, we've engineered it."

Islas-Hooker says her program has tried to create greater access to fresh food by holding farm stands on school campuses.

"In Fresno, there was actually a zoning ordinance that prohibited the establishment of farmers markets," she says. "We had to go in and work at creating a new city ordinance that would allow farmers markets in the last year."

Mark Arax, a former Los Angeles Times reporter and author of the book West of the West was born in and lives in Fresno, the grandson of an Armenian fruit picker.

"We're living in a region that produces the finest fruits and vegetables in the world, and yet the children of this valley rarely taste those fruits and vegetables," he says.

Alongside the most intensive farm belt the world has ever known, he says, is this stunning poverty. Some neighborhoods in Fresno have the most concentrated poverty of any city in the country, and all the pathology that goes along with it: the drugs and the gangs.

"We produce more meth and more milk than any region in the country," he says.

A Hidden Kitchen Vision

In Bakersfield, another grassroots kitchen effort sprang up from a nutrition class that became The Greenfield Walking Group. Made up mostly of immigrant Latina women, the group is working with the mayor and city council to rid the neighborhood park of stray dogs, drugs, gangs and graffiti, and to create walking paths and playground equipment. The members walk daily, exercise to blaring merengue music, and share potluck meals of enchiladas, chilaquiles and jicama pico de gallo.

"When I saw the women walking around the park, I thought, 'I can do this,' " says Beatriz Basulto. "I am in this group because I am obese and I need to lose weight. When I started, I couldn't get one turn around the park; it was too hard for me. Now I am doing more than 80 abdominals every day."

Across the Central Valley, little inroads are being made to improve public space and the environment that lead to healthier individuals and healthier communities.

"As long as people are indoors because of their fear, they won't come out," Islas-Hooker says. "If we created more forums for neighbors to meet each other — days in the park, farmers markets, community gardens, environments that promote a healthy lifestyle — there's real power when the community members themselves advocate for these changes."