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The pediatric and adolescent primary care clinics at Boston Medical Center (BMC) provide healthcare to numerous Boston youth, many of whom are overweight or at-risk-for overweight. The incidence of childhood overweight is known to be higher in lower socioeconomic and minority populations, precisely the patient populations served by BMC. One study conducted at BMC, for example, demonstrated that 37% of Haitian children followed at the hospital's pediatric primary care clinic were overweight. Like many medical centers, BMC lacked a sustained overweight prevention and treatment program at the beginning of 2002.

Jason Langheier, Founder of Fitness Forward, with the support and guidance of Barry Zuckerman, MD, Chairman of Pediatrics , recruited the leadership of Caroline Apovian, MD and Diana Cullum-Dugan, RD, the Medical Director and Clinical Coordinator, respectively, of BMC's Adult Nutrition & Weight Management Center, to design and pilot a multidisciplinary pediatric overweight treatment program dubbed the Nutrition & Fitness for Life Program.

The pilot program consisted of medical, nutritional, and physical activity counseling and emphasized family-centered lifestyle modification. A large referral list was quickly generated and seventeen overweight patients and their families, respectively, were selected to enroll in the program. The clinic featured a combination of personalized clinical assessment and treatment and practical, reinforcing offerings such as fitness sessions and cooking demonstrations. The pilot program helped patients to achieve healthy changes in their dietary and physical activity behaviors, and to improve their BMI status and overall health.

With the interim leadership and guidance of many members of the Department of Pediatrics, the Nutrition Department, Dr. Caroline Apovian and Diana Cullum-Dugan, and Mr. Langheier, the Nutrition & Fitness for Life Program developed into an official clinical specialty program at BMC in September of 2002. At this time, Rishi Shukla was recruited to serve as the clinical coordinator of the program.

In December of 2002, Dr. Caroline Apovian and Mr. Shukla proposed a long-term expansion plan that sought to increase program capacity, to enhance clinical services, and to develop a comprehensive community-based arm of the program. During the summer of 2003, the program's expansion proposal was implemented.

Carine Lenders, MD, MS, and Vivien Morris, MS, MPH, RD, LDN, two highly respected and experienced experts in the fields of childhood nutrition and overweight, were successfully recruited to serve as the Medical and Administrative Directors , respectively, of the program. The expansion also included the addition of a behaviorist, an outreach coordinator, nutritionists, and an attending physician.

The expanded clinical program is dedicated to offering patients and their families comprehensive and personalized weight management services. The current model features: family-based behavioral modification; personalized medical, nutritional, and physical activity counseling; group treatment; and support groups. Interactive, engaging, and reinforcing fitness sessions and cooking demonstrations complement the clinical program. The clinic currently provides treatment to more than 150 families and expects to increase capacity to upwards of 400 families annually in the near future.

The community branch of the program strives to implement nutrition and physical activity programming for youth through effective collaborations and partnerships; to provide practical nutrition and fitness education and training sessions to a multitude of community groups and leaders; to empower children and families to make sound nutrition and physical activity related decisions; and to influence public policy to support healthy behaviors. The program continues to deliver conferences and trainings to various groups, provides after school nutrition and fitness programs, and is partnering with local organizations to affect positive change at many levels.

The Nutrition & Fitness for Life Program is an innovative clinical- and community-focused weight management and overweight prevention program aspiring to combat systematically the epidemic of childhood overweight.


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