Food deserts are the collection of deprived food environments and limit local residents from accessing healthy and affordable food. This dissertation research in San Lorenzo, Paraguay tests if the assumptions about food deserts in the Global North are also relevant to the Global South. In the Global South, the recent growth of supermarkets is transforming local food environments and may worsen residential food access, such as through emerging more food deserts globally. This dissertation research blends the tools, theories, and frameworks from clinical nutrition, public health, and anthropology to identify the form and impact of food deserts in the market city of San Lorenzo, Paraguay. The downtown food retail district and the neighborhood food environment in San Lorenzo were mapped to assess what stores and markets are used by residents. The food stores include a variety of formal (supermarkets) and informal (local corner stores and market vendors) market sources. Food stores were characterized using an adapted version of the Nutrition Environment Measures Survey for Stores (NEMS-S) to measure store food availability, affordability, and quality. A major goal in this dissertation was to identify how and why residents select a type of food store source over another using various ethnographic interviewing techniques. Residential store selection was linked to the NEMS-S measures to establish a connection between the objective quality of the local food environment, residential behaviors in the local food environment, and nutritional health status. Using a sample of 68 households in one neighborhood, modeling suggested the quality of local food environment does effect weight (measure as body mass index), especially for those who have lived longer in poorer food environments. More generally, I find that San Lorenzo is a city-wide food desert, suggesting that research needs to establish more nuanced categories of poor food environments to address how food environments emerge health concerns in the Global South.