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Nutrition Counseling for Local Kids

Learn how a local nutrition provider and pediatric practice teamed up to offer dietary counseling to low-income families

By Harley Webley, MPH Candidate, Yale School of Public Health

Intern, Mid Shore Health Improvement Coalition


The Eastern Shore is home to some of Maryland's wealthiest counties. It also faces substantial income inequality. In the Mid-Shore Region, which includes Kent, Queen Anne's, Caroline, Talbot, and Dorchester counties, approximately 48.5% of K-12 grade students and their families are classified as low-income based on eligibility for the Free and Reduced-Price School Meals program (MSDE, 2021).

Affordability influences access to healthy foods, that support dietary patterns. In Maryland, 2 out of 5 adolescents consume less than one serving of fruits and vegetables per day, and 12.8% of high school students are obese and come from low-income families.

In response, Nate Bratko MS CNS LDN, a licensed dietitian, and certified nutritionist, worked with Bay Pediatrics, a local pediatric medical practice, to establish an online practice for dietary counseling and personalized nutrition support to enhance healthy eating habits and behaviors in low-income youth and adults in the rural Mid-Shore region. The goal was to improve preference for and consumption of nutritious foods, including fruits and vegetables.

How the program works

Low-income families received a stipend to facilitate their participation in counseling sessions. They were given the option to meet in person or virtually and could participate in either Medical Nutrition Therapy (MNT) or Telehealth Nutrition Services (TNS). This provided individuals with the convenience to access nutrition services in a manner that best suited their preferences and circumstances. To initiate the process, clients underwent screening for preauthorization, physician referral, and eligibility for Medicaid or other health insurance coverage.

The first session comprised of a general intake, with 30 minutes to understand current dietary habits, including social and medical history that contribute to eating habits, and 15 minutes on treatment and education. Clients were scheduled for two follow-up sessions, each lasting 25 minutes, to monitor changes in weight and BMI. At the end of each session, clients also received nutrition education handouts and materials to enhance their understanding and self-efficacy in adopting healthier behaviors. The structured approach ensured a comprehensive and ongoing support system for individuals seeking nutrition guidance and improvement.


The Outcomes

The pilot project reached 49 youth and adults through individual, in-person Medical Nutrition Therapy (MNT) sessions, and an additional 2 individuals through individual Telehealth Nutrition Services (TNS) sessions. A website was developed ( and the program provider obtained licensing for a HIPAA-compliant Video Telehealth Office and Nutrition Service. Currently, the program has four contracts with partnering healthcare organizations and is pending approval with three others, reflecting collaborative efforts to boost the initiative beyond the partnership with Bay Pediatrics.

Lessons Learned and Looking Ahead to the Future

Dietitians and nutritionists are crucial in guiding individuals toward healthy lifestyles and assisting in disease management. Unfortunately, the services they provide are frequently inaccessible to low-income families due to financial constraints and a lack of insurance coverage. This financial barrier often hinders those who could benefit the most. The current program serves as an example of efforts to improve access to nutrition therapy, but further resources are needed to address and overcome these challenges comprehensively.


This program was funded in part by a start-up grant from the Mid Shore Health Improvement Coalition. To learn more, please contact:

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