Urban Aboriginal peoples are at higher risk to a variety of chronic diseases, compared with other Canadians. Social determinants of health, socio-ecological approaches to health, and life course perspectives can identify some of the various factors that contribute to this excess risk. The complexity of these factors suggests that an effective strategy for reducing this risk might be to focus on improving the capacity of the local public health system that serves Aboriginal people and families, rather than on interventions aimed solely at individual health behaviour change. This article uses the Healthy Weights Connection intervention as an example of one of several systems-focussed and collaborative approaches to improving the health of urban Aboriginal people. Despite their potential utility, we suggest that there are unique considerations for implementing and evaluating such interventions in an urban Aboriginal context.