Pediatrics - Nutrition and Fitness for Life

The Nutrition and Fitness for Life Program was initiated in May 2002 by Caroline Apovian, MD, director of the Center for Weight Management and Nutrition at BMC and Barry Zuckerman, MD, chair of the Department of Pediatrics at BMC, as a clinical pilot project to identify the feasibility and success of an adolescent weight management clinic. The pilot clinic offered medical, nutritional and physical activity counseling with adjunct initiatives.

The program was expanded in the summer 2003 under the leadership of Carine Lenders, MD, and clinical dietician, Vivien Morris, who focused on the pediatric weight management clinic and community-based interventions, respectively.

The Nutrition & Fitness for Life Program serves approximately 400 families through its two arms, provides education and training to primary and specialty health providers, community leaders, undergraduate students and medical students.

In 2009, the Nutrition & Fitness for Life clinic began a secondary prevention program focusing on children under six years of age who are overweight or rapidly gaining weight such that they are at risk of overweight.

The Nutrition and Fitness for Life Program's specialty weight management clinic provides a comprehensive family and behavioral approach, as this is the sole evidence-based approach in pediatrics that has proven successful in treating obesity in children. However, many families are not ready for behavior management and need counseling sessions on roles and responsibilities, communication and motivation.

The core program focuses on motivation and readiness to change. The initial visit includes a physician and dietitian visit for in-depth medical, nutritional and physical activity assessment of the patient, as well as a psychological screening. At the end of the visit, an action plan is developed for the family.

A typical patient receives the following services each year

• Assessment and evaluation by physician and dietitian
• A lifestyle change intervention (action plan) with intensive treatment during six clinic visits within three to six months followed by maintenance visits up to one year
• Psychologist treatment plan based on initial screening
• Maintenance and relapse prevention visits with the clinical team

The Nutrition and Fitness for Life clinical team follows children with more complex medical issues more frequently. Care plans are developed in conjunction with primary care and other specialty clinics, such as endocrinology, child psychology, sleep lab, ear, nose and throat and cardiology. Approximately 13 percent of Nutrition & Fitness for Life's patients require ongoing psychological counseling because stigmatization, depression and diminished quality of life from teasing and social marginalization are part of the profound psychological impact of being overweight.

Duration

Nutrition and Fitness for Life is designed as a 12-month clinical program including 3 to 6 months of intensive treatment followed by maintenance sessions. The program tailors care to each family's needs.

Eligibility

A referral from a Primary Care Physician is required for evaluation and treatment in the Nutrition & Fitness for Life clinic. Please see the eligibility criteria below. The Nutrition and Fitness for Life Patient Brochure has information regarding our current services.

Carine Lenders, MD, MS, ScD
Medical Director

Dr. Lenders has been the medical director of the Nutrition & Fitness for Life Program since 2003. She also heads the Pediatric Nutrition Support Services at Boston Medical Center, and she serves as attending physician for the Nutrition Support Team at the Children's Hospital of Boston.

Dr. Lenders is a former family practitioner with a master's degree in tropical medicine, who graduated with honors from the State University of Liege, Belgium. She spent several months in the Congo with Médecins sans Frontières and three years in Bangladesh at the International Center of Diarrheal Diseases and Research.

She was a fellow in pediatric nutrition at the Children's Hospital of Philadelphia (University of Pennsylvania School of Medicine), a resident in pediatrics at the Massachusetts General Hospital, and a fellow in the Combined Program of Pediatric Gastroenterology (MGH and Children's Hospital of Boston-CHB) at Harvard Medical School. She also served as the co-director of the Optimal Weight for Life (OWL) program at CHB from 1998 to 2003.

She is board certified by the American Board of Pediatrics and the American Board of Physician Nutrition Specialists. Dr. Lenders is also an assistant professor at Boston University Chobanian & Avedisian School of Medicine and on faculty at Harvard Medical School. She has received several education grants and is involved in the vertical integration of nutrition at Boston University Chobanian & Avedisian School of Medicine. She recently edited a clinical guide book on overweight and obesity with Caroline Apovian, MD, that earned an outstanding review in the Journal of the American Medical Association. Her current research interests include the relationship of selective dietary components and medications to weight gain and obesity-related conditions.

Clinicians

Aimée Lim-Miller, MSW, LICSW
Social Worker
Aimée Lim-Miller is the clinical social worker for the Nutrition & Fitness for Life Program, providing individualized psycho-social assessments and interventions for patients and their families. She has clinical experience in acute pediatric psychiatry, family and individual therapy and pediatric psychotherapy groups. She was the Senior Clinical Case Manager for McLean & Franciscans Children's Hospital Inpatient unit.

Aimée has a BA in Psychology and Art from the State University of New York, Plattsburgh and Master's in Social Work from Simmons College School of Social Work . She is a 2009 Fellow graduate of the Children's Hospital Boston LEND program at the Institute for Community Inclusion focused on public policy, advocacy, diversity, stigma, human rights, and developmental disabilities. Her graduate clinical training was in outpatient psychotherapy at Beth Israel Deaconess Hospital and in a community nursing and rehabilitation center. She is a member of the National Association of Social Workers. She is interested in nutrition, community health, cross-cultural issues and social barriers related to obesity. She enjoys spending time with her family, dancing, cooking, organic gardening, and travel.

Kathy Ireland, MS, RD, LDN
Clinical Dietician and Program Coordinator

Kathy Ireland is a clinical dietitian for the Nutrition & Fitness for Life clinic as well as the clinic coordinator. As a dietitian with Nutrition & Fitness for Life, she helps families make the necessary lifestyle changes to achieve a healthier weight. Whether talking about food, fitness, or parenting skills, Kathy always strives to motivate families to make the changes most relevant to them and creates a personalized approach to weight management for each family.

Kathy has been working as a dietitian since 2003 and her career has always focused on working with under-served communities. She got her start in New York City working first with a program that brought cooking and nutrition activities into classrooms and then managing Kids Cafes for the Food Bank for New York City. Since relocating to Boston in 2005, Kathy worked for 5 years in the Dorchester neighborhoods of Codman Square and Fields Corner managing a diabetes initiative for DotWell.

A proud native of Brockton, MA, Kathy got graduated from the University of New Hampshire before getting a graduate degree in nutrition from Penn State. Her master's thesis focused on proper feeding practices for pre-school aged children. She completed her dietetic internship at the Hines VA Hospital outside of Chicago, IL. Kathy has also received a certificate in pediatric weight management from the Commission of Dietetic Registration. When not at BMC, Kathy can be found on the roads of Boston training for the Boston Marathon, running local road races, biking, hiking, or staying in her apartment cooking up a tasty (and healthy!) meal.

Non-Clinicians

Eunice Santos
Scheduling/Admin Coordinator

The Nutrition and Fitness for Life Clinic has received funding for patients and clinical operations from the Department of Pediatrics at Boston Medical Center, the Massachusetts Vitamin Litigation Settlement, the Boston Red Sox Foundation, the Fleet Perpetual Trust for Charitable Giving, Bank of America, the Carl and Ruth Shapiro Family Foundation, Loomis, Sayles & Company, LP, the American Heart Association and the BMC Kids Fund.

Thank You! The Nutrition and Fitness for Life Program thanks the following individuals for their service to the program.

To call the clinic directly, call 617.414.4841.

Your appointment will take place on the Boston Medical Center campus at the following location:

Yawkey Ambulatory Care Center
6th Floor
850 Harrison Avenue
Boston, MA 02118

Directions and a campus map are available to help you find our office.

Refer a Patient

We are committed to providing a high level of assistance to our physician colleagues within BMC and outside of the BMC system, as well. Whether for diagnostics, treatment, a single consultation, second opinion or ongoing follow up, our physicians will keep the consulting physician fully informed of the patient's treatment plan and coordinate long-term management.

Contact Information

Call: 617.414.4841
Fax: 617.414.3644

Special Instructions

For BMC PCP:Please fill out referral form in Logician. Please also call the Nutrition & Fitness for Life line at 617.414.4841 or flag Eunice Santos in Logician to make sure the referral is received and processed.

For Non-BMC PCP: Please complete referral form.
Please attach a patient's growth charts and relevant recent lab work and fax the form to 617.414.3644.

Admit/Transfer a Patient

To transfer or admit a patient, please call our One-Call patient admitting service, accessible 24/7. Pager number: 617.638.5795, #1111.

Education and Training

Boston Medical Center's Nutrition & Fitness for Life Program participates in various education and training programs, including:

• Vertical integration of nutrition and weight management in the medical school curriculum
• Fourth year advanced-pediatric-nutrition elective for Boston University Chobanian & Avedisian School of Medicine medical students
• "Obesity Cycle," A Teacher's Guide to Pediatric Nutrition website
• Yearly CMEs and CEUs for health professionals with interests in pediatric ambulatory weight management
• Nutrition education for families and community leaders
• More than 200 regional and national presentations