No foods are off-limits because the program isn't a diet, Dolgoff said. But, foods high in fat, sugar and calories are considered "red light" foods; in other words, "treats" that the child is only allowed to eat twice a week.
"It doesn't mean that you can never eat them, but we have to stop and think, 'Do I want to make this choice?'" Dolgoff said. "Sometimes, you're going to get a temper tantrum. That's just the way it goes. But, after a while, the kids learn sometimes they can have those unhealthy foods and sometimes they can't."
"Green light" foods are high in protein, fiber and nutrients. This includes lean meats, whole grains and fruits and veggies. One key is involving the child in the selection process at the store and making the experience fun, Dolgoff said.
Dolgoff also taught Cohen, Samantha's mom, how to read nutrition labels and how to make sense of tricky packaging. She shows her how to look for low-calorie and low-fat dessert options so Samantha doesn't feel deprived.
"It seemed fun and doable and I'm very excited," Cohen said. "I can't wait to get going. It's going to be challenging but I think overall it will work out. ... You just don't think to analyze food labels the way she taught me to do today. We will certainly be paying a lot more attention in the supermarket."
At the weight clinic in Tennessee, nutrition is also a big emphasis. The team at the clinic planned to create a road map specific to Nick's needs. But before making any suggestions, they first had to figure out what was going on at home.
"What is dinner usually like?" dietitian Amy Freedman said.
"It's usually a meat and two vegetables, and then we fix him macaroni and cheese every night because that's the only thing he'll eat," Reeves said.
"When it comes to that stuff I'll eat the whole pan," said Nick.
"And then some kind of roll or corn bread," said Reeves.
Amy asked about the weekends.
"Usually, it's a fast-food place," Reeves said. "His favorite place is Wendy's, and he would usually get..."
Nick interrupted: "A double stack and fries,"with a sweet tea to drink.
"He's always hungry," Reeves said. "That's all I ever hear from him."
Plemmons asked Nick questions about other habits. Did he have a TV in his bedroom? Yes. Play Station 2? Yes. Nintendo? Yes. Xbox? Yes.
Plemmons asked if mother and son took any walks together.
"No," Nick said.
"He played basketball this past fall and he started wheezing and coughing," Reeves said.
Plemmons said Nick was just young enough that his condition was still reversible.
"The older you are when you struggle with it, the more predictive it's going to be life-long," Plemmons said. "Right about his age right now, 50 percent of the kids that I see that are in this state are going to stay that way. So I think 50-50 is pretty good odds."
Next, Nick met with a physical therapist. At the end of the appointment, he was given a list of individualized goals.
"We really tried to stress with Nicholas today primarily nutrition goals," Plemmons said. "The one goal I hope that he keeps is cutting back on the Gatorade. I think that's where a lot of his extra calories are sneaking in."
If Nick could maintain his current weight over the next several months, while also growing taller, his BMI would drop and that would mean success.