According to the Centers for Disease Control and Prevention, Kentucky’s self-reported prevalence of obesity among adults is 31.6%, among the highest in the United States. Prevalence of related diseases, such as diabetes, cardiovascular diseases, asthma, and some cancers, is directly proportional. In 2014, 11.3% of Kentucky’s adult population diabetic. According to the American Heart Association, heart disease and stroke are the leading causes of death in Kentucky, accounting for 28% of deaths in 2010. The Food Research and Action Center reports a positive correlation between poverty and obesity, and counties in Kentucky with the highest percentage of poverty, have the highest percentage of adult obesity and diabetes.

To address these issues, UK and KSU EFNEP and SNAP-Ed Nutrition Education Program Assistants deliver nutrition education to limited resource adult audiences in Kentucky using the Healthy Choices for Every Body (HCEB) curriculum. HCEB teaches limited-resource adults about planning nutritious meals on limited budgets, safe food-handling practices, and appropriate food preparation skills needed for a healthy lifestyle. HCEB incorporates lessons and activities that recognize participants’ experiences, skills, and knowledge; explains why, what, and how the nutrition education concepts presented relate to real-life situations; and includes active learning activities, hands-on practice, and demonstrations to help participants understand and apply content. Topics on physical activity and practical ideas for adopting a physically active lifestyle are included in each lesson.

Participant outcomes are measured using the EFNEP NEERS evaluation tool and Kentucky Behavior questionnaire. The pre/post evaluation of 5,656 graduates find the following program outcomes resulted:

• 70%  showed improvements in the item “Ate more than one kind of fruit.”
• 65% showed improvements in the item “Ate more than one kind of vegetable.”
• 66% showed gains in their daily consumption of water (i.e., drinking at least 6 cups everyday).  
• 52% drank soda less often and 46% drank other sweetened beverages less often.
• 66% consumed low fat milk and dairy products more often.
• 47% reduced their consumption of refined grains.
• 47% increased the cups of fruits consumed per day (by average of 0.75 cups).
• 47% increased the cups of vegetables consumed per day (by average of 0.65 cups).
• 67%  more often think about healthy choices when deciding what to feed their families.
• 77% showed improvements in using Nutrition Facts to make food choices.
• 35% improved their food security status by being less likely not to have enough food for the month.
• 64% reported improvements in comparing prices before buying foods.
• 60% showed gains in buying foods on sale, and 65% showed gains in using coupons for grocery shopping.
• 67% used shopping lists more often.
• 62% showed improvements in exercising for at least 30 minutes more days a week, and 70% improved in making small changes to be more active.
• 53% increased their involvement in strengthening exercises.
• 47% washed their hands (before preparing food) more often, and 46% improved in cleaning item/surfaces after contact with raw meat/seafood.
• 74% showed gains in the use of meat thermometers.
• 72% thawed food at room temperature less often.

In addition to these participant outcomes, the HCEB curriculum has been evaluated from various standpoints to determine program effectiveness and establish it as an evidence based curriculum. As a result of these scholarly efforts, the curriculum was selected to be part of the National SNAP-Ed toolkit and will potentially be used by programs across the nation.