By Scott Kearnan - “Eat your colors every day.” A simple, friendly reminder, these words adorn a poster that hangs on a wall inside the Holyoke Health Center (HHC). And in this room, on this Tuesday morning, colors are everywhere: orange tangerines sitting out in a fruit bowl; blue, pink, and green aprons worn by community health workers cooking breakfast in a small kitchenette; and yellow omelets for the dozen clients, all members of Holyoke’s large Latino community, assembled to eat them at long tables. At the front of the room is Maria Fessia, HHC’s Healthy Weight Healthy Heart program manager. Dressed in sharp red, she holds in her hand small plastic cups—orange, green, and yellow—and uses them to teach those in attendance about appropriate portion control. Gesturing to a series of posters, she guides this morning's nutrition class through the tiers of the food pyramid and the colors of foodstuffs—green veggies, white rice, and brown bread—contained within.

“We teach them about choosing the right foods … but that you don’t have to give up culturally important items,” says Fessia, in between fielding questions about diet, exercise, and smoking cessation from those in attendance. Fessia is enthusiastic about the mission of the Healthy Weight Healthy Heart program, which has been expanded and sustained over the last three years thanks to the Foundation’s Closing the Gap on Health Care Disparities grant.

Disparities surrounding weight issues and the resultant health consequences—especially cardiovascular disease and diabetes—have been a problem for HHC’s Latino clients, many of whom come from low-income households and have difficulty accessing or affording the fresh foods and produce that promote healthy weight. Language barriers and low literacy rates are another obstacle, so Fessia incorporates a supermarket tour as part of the program’s 10-week curriculum: she brings participants to a local grocery store to teach them how to read important nutrition facts; memorize options by site and color if not language (red bottle caps for skim milk, for example); and identify important logos, like that of the American Heart Association, that indicate a healthy choice. Part of the program’s expansion also includes a daily exercise class where participants gather for aerobics and light weights, and to support each other in maintaining a healthier lifestyle.

The program is yielding great results for its participants, young and old.

“It wasn’t easy, but I feel better and healthier,” says Wanda Estrada, 35. The Holyoke resident has lost nearly 30 pounds since she began participating in the program, which she joined when a routine health screening indicated that her blood pressure was high. Like many of Holyoke’s Latino clients, Estrada was accustomed to a diet that emphasized skipping breakfast and lunch for a large dinner that consisted of high-fat foods. She says she makes more moderate choices now, which has resulted in weight loss, improved blood pressure, and progress around issues of depression. Fessia says that a high incidence of mental health issues in HHC clients are another problem compounding healthy choices.

“I didn’t know how to eat properly,” admits Esperanza Marquez. “It was a challenge to learn, but now I feel great.” At age 70, Marquez has also dropped nearly 30 pounds and improved her health since starting the program.

“She has had perfect attendance, every day for a year!” gushes Fessia as Marquez smiles, flushed but satisfied after another exercise class.

Healthy Weight Healthy Heart isn’t the only program supported by the Foundation’s three-year grant, although, as Diabetes Program Manager Dawn Heffernan says, "[the grant] was critical in the sustainability of that program." She says that the grant also helped HHC integrate its healthy weight services and Community Health Worker staff with existing diabetes-specific activities.

“We needed to rethink and reintegrate all these programs,” says Jon Liebman, nurse practitioner at HHC. “There has been a history of disease-specific funding … but the solutions are broader than that,” he adds, citing the flexibility of the Foundation’s grant in allowing HHC to address more comprehensive notions of care. “It’s not just about paying for an exercise class or a nutritionist … It's about, how do you support the whole system? You collect enough data to figure out who’s having trouble, and you provide them services that are the whole package.”

To that end, HHC has also implemented a smoking cessation program that assesses the smoking status of each adult patient at every clinic visit, and is prepared with stage-based educational material and intervention services to treat clients wherever they are in the cessation process. Development and implementation of a bilingual Chronic Disease Self-Management program has also allowed HHC to give patients the tools to monitor and care for their health outside the center’s four walls; in 2008, 85 percent of patients were enrolled in programs with self-management goals compared to 50 percent in 2007. “The big programmatic success is [developing] supportive services for people with chronic diseases and integrating [that success] into primary care,” says Liebman. “That doesn’t often happen. You go to support groups and get education, but it’s not usually integrated into primary care.”

In these ways, the grant period has allowed HHC to integrate multiple levels of care into a single system, as if balancing the tiers of the food pyramid.

“The issue with patients is always: Where can you put in resources to make a big impact?” says Liebman. Dollar for dollar, and pound for pound, HHC has inspired a colorful impact, indeed.