M. P. Ravindra Nathan

�Today is a day for happiness and gratitude, and you should experience them in abundance. Success requires constant intellectual effort and during your college years, you have grown toward this ideal. You should be proud of your proficiency and conduct both in and out of the classroom.�

These are the words of Guy H. Bailey, chancellor of University of Missouri, Kansas City (UMKC) to all the graduating medical students of 2007. And I was present at UMKC on May 25, 2007 to attend the commencement ceremony and see our nephew Vineet Venugopal graduating from the M.D. honors program, a culmination of six years of intense study.

The dean of the Medical School, Betty M. Drees, reminded all the graduates that �it is indeed an incredible honor to be here today, but the work is not over � your responsibility takes a different course.� She meant that residency and fellowships about to follow would be equally challenging. Then she added, �We are what we repeatedly do, so excellence is a habit, not an occasional occurrence.� I couldn�t agree with her more.

A Ralph Emerson quote printed on the booklet circulated, also is relevant: �What lies behind us and what lies before us are tiny matters compared to what lies within us.� How true!

Here are the stats on how students entering into these accelerated programs do. Of the 116 who accepted into the UMKC program 30 dropped out and, the rest 86 received their baccalaureate/doctor of medicine degrees at the UMMC School of Medicine 2007. At least 15 were of Asian Indian descent, a covetable achievement for our minority. And to top it all, one of them, Robin Kamal won many honors, including the Outstanding Achievement in Medical Education, UMKC School of Medicine Award for Research and Harry S. Jonas M.D award. I caught up with his father Syed Kamal from Uttar Pradesh and he was understandably proud of his son�s achievements.

Robin also was the class speaker on this day, a rare honor. During his speech he enumerated the many obstacles and hurdles he and his colleagues had to overcome and the �enormous price one has to pay for getting the honor of MD but once you get it, it is priceless.�

The graduating students were spotlighted in their P.R.N. magazine with their photos and comments. Nearly everyone credited their parents and God for their success. So, to all parents out there: you have the ability to mold your children and make them successful. Credit also should go to the faculty mentors who guided them since they tend to model real learning, academic honesty and integrity after them.

While I sat in one of the back chairs soaking the atmosphere, I reflected on my own graduation about 44 years ago in a Kerala Medical School campus, India. I must say these functions are so much colorful today with a lot of pomp and glory, attended by the graduate�s parents and other family members and friends. I still remember the words of my professor K.N. Pai, the keynote speaker who quoted from the famous novel �Magnificent Obsession,�: �You have all taken the Hippocratic Oath. And you should approach every one of your patients with courtesy and compassion. Always remember �primum non nocere� � do no harm.�

I don�t know how many doctors actually remember these principles during their daily practice these days. Medical practice has changed over the years and we all have become quite busy with little time left to talk to the patients. One of the rages among malpractice lawyers is the so called �medical errors� � yes, you have heard the gruesome stories of wrong medicines administered, wrong surgery done on patients, missed cancer on biopsy specimens etc. Hopefully, the old-fashioned �bed side medicine� can coexist with technological advances, the main focus in current medical practice. Even Hippocrates couldn�t have envisioned this �metamorphosis in medicine� when he designed his oath for physicians 3,000 years ago.

Finally, to all the youngsters in our community: Medicine is still a wonderful and noble profession and indeed an excellent career to pursue if you are interested in the field. It will never go out of fashion. As we conquer old diseases, new diseases seem to appear on the horizon. As long as man is alive, he will be susceptible to illnesses needing prompt care.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

	Payal Patel

If you look around these days, it is easy to spot a child who is overweight now more than in the past. Obesity was once considered an adult problem but now also affects children. Obesity has become a growing epidemic that is not only affecting the United States but also the world. It is considered a healthcare crisis that we as doctors, parents and teachers have to fight together. In this four-part article, I would like to start out by talking about what obesity is, and the causes and its associated risks. Next will be prevention, followed by two parts of weight management strategies.

Nearly 25 percent of children in the United States are considered overweight. The causes of obesity include genetic as well as external influences. We can blame our now sedentary lifestyle. These days, more kids spend time indoors playing videogames and watching TV then playing outside. Parents are responsible for this behavior because they are role models for their kids. Since we as adults work all day, we are too tired to spend outdoors time with our kids on a daily basis. Therefore, not only do we tend to become overweight, but so do our kids.

Another problem is the ease access we have to all types of food. It is convenient to go to a Burger King, McDonalds or a Taco Bell when parents are tired or on the go. These foods if eaten even 2-3 times per week can easily add to the weight gain. We have all been to the grocery store or a restaurant and realized that healthy foods come with a hefty price, which is difficult for middle- and low-income families to afford.

Parental obesity plays a large part in determining a child�s weight as an adult. Genes play a large role in determining obesity, along with external factors such as the parents eating behavior as well as their sedentary lifestyle which are psychosocial factors. Obese children less than 5 years old have a three times increased risk of being obese as adults. An adolescent (teenager) who is overweight has a 70 percent chance of being obese at 35 years of age.

The adult complications of obesity start much earlier in children who are at risk of obesity, and are already demonstrating signs and symptoms of weight gain. The complications include high cholesterol, hypertension, diabetes, accelerated puberty, sleep apnea, many types of bone-related problems, liver problems, emotional and psychosocial problems, etc.

It is our job as pediatricians, parents and teachers to educate our children, as well as take an active role in changing our own behaviors to influence our kids by implementing healthy eating habits, as well as exercise into our daily lives. Parents are the biggest role model for their kids.

Every child that comes to the doctor�s office should have their blood pressure checked and their weight and height plotted on a growth chart at all well visits/yearly physicals. If a child is determined to be overweight, then a BMI (Body Mass Index) should be calculated by the doctor and explained to the parents. Another important assessment for overweight or obese children is blood work to check for glucose, thyroid and cholesterol.

In my next article, I will write about prevention in detail.

Payal Patel, a board-certified pediatrician, is at Sunshine Pediatrics, (next to Cheval), 18928 N. Dale Mabry Highway, Suite 102, Lutz, FL 33548. She also can be reached at (813) 948-2679.