Dreams come true like presto, chango! -- such as when Santa Claus brings a palomino pony, or Prince Charming holds out a diamond ring.

Then there are dreams that come true after years of work and creative thinking and team building. Dreams like this are the kind Prince Charming, or even Santa Claus, can't deliver. They are the kind only the dreamer can realize.

Dr. Tracy Macpherson is realizing one such dream, one she has had tucked inside her head while a physical education major at the University of Texas in San Antonio, a graduate of the University of South Carolina in Exercise Physiology, and then as she became a pediatrician at the Medical University of South Carolina. It's a dream she's clung to and worked toward while practicing medicine at the Pediatric Clinic in Orangeburg for many years.

Hers is an unselfish dream, and it's a providential dream, one whose time has come just as she reached a point where she was ready to realize it.

Her dream is the creation of a pediatric obesity clinic. The "Highway to Healthy Lifestyles Clinic" opened officially Wednesday, with the beginning of the new year, and each Wednesday thereafter will be allotted to children referred to the new clinic.

Macpherson had long talked with her fellow Orangeburg pediatrician, Dr. Karen L. Connelly, also on staff at The Pediatric Clinic of Orangeburg, and other dreamers have now joined them for a multi-disciplinary approach to the problem that 2006 brought to the forefront as one of the greatest health nemeses in present-day America.

Along the "Highway to Healthy LIfestyles," children may meet either of the two doctors, and other members of the "dream team" who work at the Pediatric Clinic: Rebecca Hornung, pediatric nurse practitioner; Jennifer Graves, physician's assistant; or, on an as-needed basis, licensed psychotherapist Katie Fogle.

Also on the team's list, which is not yet all-inclusive, are dietician Carmen Thompson with Region 5 of the South Carolina Department of Health and Environmental Control, who will work in an advisory capacity in nutrition counseling, and sisters June Fanning of Fit-for-Life and April Thomas of April's Gymnastics, who will be available for fitness counseling and have already been conducting fitness classes at the local public schools.

"One of the reasons I got into pediatrics is that I was very interested in doing preventive medicine," Macpherson recalls. "When children come into my office, I've always talked to them about exercise and nutrition in addition to school and routine health care matters. Unfortunately, obesity has exploded now to the point where it needs to be addressed as a separate entity."

"There are so many kids that need so much information on obesity that goes beyond the annual physical," she added. "I noticed a huge difference in kids even from last year to this in the amount they get out and play. They have Gameboys and electronic games that keep them occupied."

The changes in lifestyle are so multifactional, she says. Safety issues have kept children from running free as they once did, but now that they are used to a sedentary lifestyle, parents have to beg some to go outside. For outdoor sports, children have to be driven across town. Or they are taken to after-school day care till it's time to come home and get their homework done. Through the day, they have constant exposure to processed and fast foods.

While the new clinic will be housed in the same building and heavily staffed by employees of the Pediatric Clinic, it will not be limited to Pediatric Clinic patients, Macpherson says.

"We will be open for referrals from the health department, the schools and other doctors," she said. "It'll be a separate entity from the Pediatric Clinic."

The clinic is the only one of its kind known to Macpherson or members of the University of South Carolina College of Medicine specialists who offered the team education in obesity treatment in October.

When Macpherson and Connelly heard that members of the University of South Carolina College of Medicine had gotten a grant for community education on the subject, they decided to take advantage of it. The Pediatric Clinic was one of only four of the 60 recipients of the offer who responded to the USC professionals.

"There are several university settings which have metabolic clinics such as this," she said, "but I or they don't know of any other private clinics like this."

The specialists will likely meet with their referrals weekly for the first four weeks. They will be given a physical by a health care provider from the Pediatric Clinic, who will note their height, weight, body mass index, blood pressure and laboratory work. When a child is overweight, there may be hypertension or metabolic problems. When the lab work is back, results will be analyzed. As time passes, they will look at the numbers for progress.

Patients will likely have two or three visits with the dietician, a fitness expert or an exercise specialist.

After the first four weeks, the patient will meet at least monthly or quarterly, depending on their needs, Macpherson notes. They will be given individualized plans.

"Some may need a formal exercise program; some children need a more private approach, and some rally around teamwork," she said.

The quality of the child's current diet determines how frequently the child will need to meet with a dietician.

Insurance coverage will likely depend on whether the child has identifiable medical problems, Macpherson explained. "It will probably pay for the first visit, and after that, it will depend on the plan."

Thompson's nutrition counseling is paid for by the state as part of DHEC.

"We realize this is probably not a money-maker but we're willing to risk it," she said.

When children start their journey at "A Highway to Healthy Lifestyles," they will receive an age-appropriate passport with a travel itinerary -- and they'll receive some travel companions who want to guide them to the healthy bodies they're hiding inside.

Why is my child obese?

One idea used by Healthy Lifestyles Clinic at Palmetto Health Children's Hospital is an eating plan Dr. Rob Hollemon, pediatric nephrologist and clinical assistant professor with the USC School of Medicine, calls the traffic light diet.

The green list is for the good foods, the yellow list means to use caution when eating those foods and tells what to order if you have to go to a fast food place, and the red light means stop -- limit these foods as much as possible.

The traffic light diet is a general plan, but children with medical problems that are causing their obesity might need individualized plans, and that's where Carmen Thompson, DHEC dietician, will be able to help.

On the other hand, some children may have medical problems that make them unable to do the exercises, which is where June Fanning and April Thomas would come in to start with low weight-bearing exercises, probably on some modified basis.

Finding another reason for child obesity besides poor nutrition and lack of exercise can be difficult. "The thyroid as a reason is rare," local pediatrician Dr. Tracy Macpherson explained, "unless they have some other finding consistent with thyroid problems. We don't test for it, per se."

By looking at the child's fasting blood sugar level and their hemoglobin A1C, the doctors can check for diabetes and blood sugar control problems. They also check for cholesterol issues, but that problem is usually familial, she said. Because insulin resistance is very common in the obese population, the clinicians will check the insulin level.

"More common as an issue is dysmetabolic syndrome," Macpherson said, "and the other is hypertension; that is age-specific. For example, 120 over 80 is an okay blood pressure for an adult, but not for a child."

Children with these diagnoses would probably need to be on medication.

Part of the physical is a thorough family history, and if high cholesterol or diabetes were in the family, the child would be considered at risk.

The body mass index, which is also age-specific, is how professionals determine that a child is "obese." A 5-year-old with a BMI of 20 would be overweight, but an adult with the same index would not.

After the first visit to the Highway to Healthy Lifestyles Clinic, behavior modification and self-esteem of the child play a big role in the effectiveness of a weight control program, Macpherson says.

"Kids who have met with success in their weight loss goals are often those who combined it with behavior modification techniques," she said, emphasizing that the parents, teachers and medical professionals are all part of a team approach to the child obesity problem.

"Sometimes you need someone behind you, holding you accountable," she said. "Grandparents and parents need to be reminded that stopping off for fast foods can be harmful to their child's health."

One of the hardest obstacles can be getting the parents involved. Macpherson says she and her co-workers have considered taking parents grocery-shopping because some don't know how to read labels or pick out healthy food.

"One idea that Dr. (Karen) Connelly uses is to tell parents and children that if the food comes off of a farm, it's okay to eat," she said, "and that's a good way to help people remember that the best food is the most basic and simple."

"Some parents say they offer them opportunities to exercise, and the child may have a bike but if the tires are flat and they have no helmet or place or time to ride it, what good will that do," she said.

The Healthy Lifestyles Clinic will also need the support of the schools to serve healthy meals and of the after-school programs, which sometimes offer entire pizzas or hot dogs as a snack.

"The problem is layered, layered, layered," Macpherson said. "I remember my parents swimming with us. But now children play organized sports and while the child is playing soccer, the parent is sitting and watching. When does the child see their parent exercise?

"Children are way too over-scheduled, and that leads to secondary problems. Studies have shown that one of the biggest influences on a child's activity level is his or her mother's activity level."

Speaking as one who jogged with her son, Skyler, in a stroller when he was two, Macpherson has run in marathons and triathlons and says more and more people are participating in them, but concurrently, "there are exponentially more people becoming more sedentary."

The Healthy Lifestyles Clinic employees are bursting with enthusiasm because they feel like they have succeeded in finding top-notch people for a multi-disciplinary approach, she said.

"All of us have been doing this and working with this for a long time, but our efforts have been segmented. Now we're taking what we've been doing and putting it together in an organized way," she beamed. "It'll be a success if people take advantage of it."

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