Countries in Southeast Asia have high and stagnant rates of undernutrition. While about 26% of children under 5 years of age are stunted (i.e. have an age inappropriate height), the region also shows continuous growth in overweight rates. It is not uncommon to find undernutrition coexisting with overweight, obesity or diet-related non-communicable diseases within the same country or even within the same household, particularly in urban settings. Food systems are an important driver for both trends. On the one hand, there is a rapid increase in the consumption of animal-based food items and highly processed food, overconsumption of which can damage health. On the other hand, consumers are becoming more aware about health and food safety resulting in a rising demand for quality and nutritious food, particularly in urban areas. Responding to that demand and facilitated by the development of modern retail, some countries in Southeast Asia are witnessing a rapid uptake of vegetable food system innovations. Specific improvements are found in the areas of quality seed, protected cultivation, smart decision-support tools and precision application of inputs. Cold chain development, food processing technology and improved logistical and financial arrangements are being adopted to reduce post-harvest losses and add value in the supply chain. However, not all innovations are health-promoting, as the region also experiences an increase in pesticide misuse. We adopt a food systems framework, looking at consumer demand behavior, food supply chains, and mediating factors in the food environment to illustrate and discuss innovations and interventions that can lead to greater vegetable production and consumption and healthier diets in Southeast Asia. On the demand side, we review options to influence consumer behavior and enhance the acceptability, desirability and affordability of vegetables. This includes information campaigns, regulating advertisements for unhealthy foods and financial incentives. Next, we zoom into supply chains and review options to increase the availability and affordability of vegetables from seed to market and across growth conditions, i.e. from open field to low-cost protected cultivation to greenhouses and ‘plant factories’. We discuss food safety concerns and options to enhance the desirability and acceptability of vegetables through the introduction of traceability and certification systems. Options to change the settings in which people access and eat food (e.g. in wet markets, supermarkets, schools, restaurants) are then reviewed to further increase the accessibility and affordability of vegetables. Addressing supply-side opportunities and demand-side motives separately may not result in lasting positive outcomes. Food systems change will require a thorough understanding of dietary gaps and consumer behavior, food environments, food supply chains and external drivers, such as climate change, urbanization, youth unemployment and migration. There is an urgent need to pilot food systems change in Southeast Asia, linking urban consumers with peri-urban and rural vegetable farmers, and aiming to achieve favorable and lasting dietary, economic and environmental outcomes at scale.