Designing, implementing and evaluating strategies to support healthy eating and active living in urban, suburban and rural communities, Lessons from LiveWell Colorado

LiveWell Colorado (LWC) provides funding for underserved communities to address obesity through healthy eating/active living strategies (HEAL). Given the scarcity of full-service grocery stores along with the abundance of fast food within many lower income neighborhoods, increasing access to affordable fresh fruits and vegetables is a key goal. We used the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) to evaluate healthy eating strategies in 20 communities funded through LWC. Strategies were implemented at the program, environment and policy level and across worksite, healthcare, school and community sectors. 250 strategies have a healthy eating component, with the potential to reach 1.2 million residents at varied levels of intensity and cost. Comparisons using RE-AIM suggest that strategies emphasizing both reach and continued access (i.e., “dose”), and that integrated food production with food distribution, will yield the highest return on investment and potential for sustainability. Evaluation challenges included the lack of sensitive measurement at the individual behavior change level (i.e., changes in fruit and vegetable consumption) and difficulty determining individual-level “dose”. Lessons learned included need for policy and infrastructure support to sustain strategies over time.