By Jillian Michaels
Guest blogger

The holiday season is upon us and this time EVERY year I write diet, fitness, and motivation tips about how to not gain weight and let your health spiral out of control. It’s nothing you haven’t heard before so honestly why the heck am I writing about this again?! Did no one listen the last 10 years?

You are not stupid. You know how to be healthy. Eat less and move more. It doesn’t take much to know that a second helping of stuffing and pumpkin pie and yams and biscuits is a bad idea.

You know all the obvious stuff… Eat white meat turkey, not dark. Do whole grain rolls instead of biscuits. Bring fitness DVDs with you if you are traveling so you can workout on the road. Create fun family fitness activities to do together such as touch football instead of sitting around eating or watching TV. And the list goes on…

Let’s get down to the bottom of it. The holidays are a time to be grateful. Grateful for the blessings you have and the ability to create new blessings symbolized by the coming of a new year. However, at a time when we should be celebrating our lives most, we are prone to depression and dysfunction. Eating becomes gluttonous. Family issues become magnified. The gym becomes a distant memory. Stress levels go through the roof and so on.

So how do we create that shift in our thinking, behavior, and overall holiday experience? Desire. The first step is to stay focused in the present tense on the things you want for yourself and in your life. Transformation doesn’t happen in the past or in the future. It happens right now. By focusing on the positive things you crave and deserve, you shift your focus from one of resignation to one of inspiration.

Start by picking a goal. Maybe the one you have been saving for January 1 and begin pursuing it immediately. Every day this season, I want you to wake up and think about that goal and how the actions you take throughout your day will bring you closer to that goal. If holiday parties create temptation for you, avoid them. Find a healthier way to celebrate with your friends like a night on the town dancing. If stressful family reunions throw you off track, set boundaries or stay away. Take a healthy vacation with close friends instead. If the memories of holiday seasons past cause you to feel lonely, channel those feelings constructively instead of destructively. Take them as a sign that it’s time to form new connections. Join a club, support group, or online community where you meet new people and make new friends. And with every decision you make ask yourself this question – “is my choice or behavior in this moment getting me closer to my goals?” If the answer is no, make a different choice.

Some of you are thinking “it’s not that simple. I have to go to my office party. I have to go to my grandmother’s house for dinner where she guilts me into eating thousands of calories. I have to let my in-laws stay with us even though they insult me.” Do you? Do you physically have to? Are you being held at gunpoint to engage in behaviors that upset or hurt you in some way? I bet 99 percent of the time the answer to that question will be no. So stop wasting time and start putting your health first, physically and emotionally. Let’s redefine the holidays as a time of inspiration and possibility one empowered person at a time. And remember, taking care of oneself is a gift to everyone else because everyone ends up having a happier and healthier holiday.

How will you maintain your health goals during the holidays?

Jillian Michaels is a fitness expert and trainer on the TV reality show "The Biggest Loser".

By David S. Martin
CNN Senior Medical Producer

An orthopedic surgeon told me the story recently about a 300-plus pound man whose feet gradually failed under his immense weight - until he walked on the inside of his ankles.

He required complicated surgery on each foot and ankle – 3 ½ hours in the OR, a night in the hospital and months of rehab each time. The bill ran into the tens of thousands of dollars for a problem largely attributable to his weight.

“Bones aren’t any bigger than they were thousands of years ago,” the surgeon told me. Unfortunately, we are. And bones and tendons don’t grow to accommodate body weight.

The debate about health care is largely about dollar figures. How much will it cost? How will it affect the deficit? How much will it raise our taxes?

There are a couple of figures that don’t often make the debate, and they may pose an even greater challenge. I’m talking about the obesity rate and the percentage of Americans who continue to smoke.

A government-sponsored study recently estimated that medical spending for obesity reached $147 billion in 2008, almost doubling in the past decade. It’s not surprising. About 32 percent of American adults are obese, a condition linked to diabetes, heart disease, even cancer. As the story above illustrates, obesity can also do a number on your bones and joints.

If you want an idea of how big $147 billion is, it’s roughly 6 percent of all health care spending in the United States.

How about smoking? Almost 21 percent of American adults are addicted to cigarettes, according to the Centers for Disease Control and Prevention. That’s more than 45 million people. The estimated health care costs pegged to smoking: $96 billion.

It’s virtually impossible to live in the United States and not be aware of the health risks associated with smoking, yet the addictive habit continues – with tragic consequences for smokers and an immense burden on the health care system.

The Congressional Budget Office caused an uproar when it projected that Obama-backed changes in the health care would add $239 billion to the deficit over 10 years.

That’s nothing compared with the cost of obesity and cigarettes. Over 10 years, those costs top $2.4 trillion.

And that leads to the obvious question: How would you get Americans to lose weight and quit smoking?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Matt Sloane
CNN Medical News Producer

When I first heard about the TOGA procedure, I have to be honest, I was a little shocked! TOGA, which stands for transoral gastroplasty, involves doctors putting a garden hose-sized tube down your throat, passing a camera and a staple gun through the tube, and stapling your stomach from the inside. Pretty cool, eh? It's the latest procedure in "natural orifice surgery," an innovative and attention-getting area of medicine. Gallbladder removal through the vagina, brain surgery through the nose, and now stomach stapling through the mouth – the very orifice where most obesity begins.

The procedure – if approved – could help take the place of laparoscopic obesity surgery, which comes with scars, and several days of recovery. Lose weight, no scars, very little recovery time, and the only complaint most people had in the clinical trials was a bad sore throat? Sounds great, but not so fast, says Dr. John F. Sweeney of the Emory University Center for Bariatric Medicine.

"This is really innovative, and it's pushing the envelope on what we're doing endoscopically," said Sweeney, "But stomach stapling really doesn't work long term."

Lets take a step back. There are two types of obesity surgery. Restrictive operations make a pouch or sleeve inside the stomach, thus making it harder for food to pass, and creating a feeling of satiety, or being full. Malabsorptive operations actually re-route the gastrointestinal anatomy, so that there is less stomach surface area to absorb the nutrients you normally take in with food, thus causing you to lose weight. TOGA, as well as procedures like the LapBand are restrictive surgeries, and although they can be very successful at first, the long-term success rate is not stellar.

"Folks often aren't compliant with their diet," said Sweeney, "Sweet eaters easily defeat restrictive operations, other folks overeat and disrupt the staple lines."

And according to a 2002 study in the journal Surgery, Body Mass Index (BMI) for patients that had undergone gastric banding operations declined for the first three years after surgery, but then began to climb – almost to pre-surgery levels in the years following.

So just who would be the right candidate for this procedure?

"The whole point of this operation is to make a pouch where large food will get stuck," said Dr. Edward Phillips, chairman of surgery at Cedars Sinai Medical Center in Los Angeles. "So, if you're a meat-and-potatoes kind of eater, you will probably do pretty well with this type of procedure."

But having done dozens of TOGA procedures himself, Phillips says, "liquid calorie eaters" tend not to lose as much weight.

"If you eat alot of ice cream or liquid calories, those kinds of things are going to pass right through the sleeve very easily."

Overall, in the first phases of clinical trials, the TOGA has resulted in an average of a 45 percent weight loss after one year. How it does after two, three or even five years? That's the big question that will determine how revolutionary the TOGA really is, and we may not get the full story for another year or two.

When the procedure becomes available, would you have the TOGA procedure done to lose weight?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

From Suzy, Raleigh North Carolina

“Dr. Gupta, I saw you on “Dancing with the Stars” this week and it was great! I started dancing about three months ago and have lost about 10 pounds. I am having fun on the program but do worry about getting injured! What can I do to lower my risk?”

Answer:

Hi Suzy, thanks for writing in. It’s great to hear you started dancing as a way to get fit. It’s a great way to burn calories without it feeling like a chore. The key for anyone looking to get in shape is to find a fitness routine you enjoy! You’ll stick with it longer and may even inspire a friend or two to join you.

Many dancers say they feel longer and leaner from just a few months of classes. Exercises like dancing, or even Pilates for example, impact the density of your muscle versus the size of the muscle. The muscle fibers are engaged differently from the way they would be in a person lifting weights. It is a great body-shaping activity, keeping the core engaged the entire time and toning and strengthening your muscles.

Of course dancing burns a lot of calories too! Fast-paced dancing (swing, ballroom, or party dancing) can burn about 360 calories per hour. Slow-paced dancing (slow ballroom or a mambo) can burn about 240 calories per hour for the average person.

But for any fan of the hit TV show, “Dancing with the Stars,”you are well aware of the injuries that can develop. Just this season, five contestants have been hurt. Nancy O’Dell had a torn meniscus; Jewel suffered a leg fracture to name a couple. Their injuries are typical – majority of dancing injures develop in the lower extremities: hip, knee, leg, ankle, foot.

To avoid injury, be careful of overuse. Overuse injuries, the most common seen among dancers, occur when a person consistently does the same movement over and over again. The muscles begin to tire, bone begins to weaken, and an injury occurs.

Studies show that during a 90-minute organized dance class, a person lands on the same leg about 200 times! Each impact is about 10 times your body weight. Imagine doing that every night? Overtime, your muscles will break down and an overuse injury will result.

So let your body rest after dancing (or any other high-intensity workout) by spacing out your workouts. For example: Avoid doing two days in a row of the same activity. Remember, it’s the repetitive motions that often cause overuse injuries. And remember that a good workout makes you alert, energizes you for the day ahead. If you are feeling sluggish, you are most likely not getting enough sleep. Sleep deprivation impacts your reaction times and overall performance, which could lead to injuries as well.

The best bet for someone looking to start dance-for-fitness regime (and avoid injury) is to cross train versus solely dancing. By making dancing ONE of the activities you do to stay in shape – not the only one – you will have fun, tone up and avoid sitting on the sidelines. Keep up the great work, Suzy!

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

Asked by JJ, Silver Spring, Maryland

"I lost a lot of weight before I reinjured my ankle (had surgery in 2005), and had my third baby. I’ve since gained it back and then some. I want to exercise, but my ankle is very arthritic and hurts when I run. What can I do to get back into shape for myself and my three children?"

Answer:
JJ, it's easy to become discouraged after suffering an injury and gaining weight. Part of the challenge of getting in shape, for anyone, is being motivated to make a change. The good news is your attitude seems to already be on the right track.

There are several low-impact exercise options you can do to get back in shape as well as provide an energy boost to play with your kids as well as reduce arthritis pain.

If you have access to a local pool, swimming is one of the best full-body workouts for you. Being in the water creates an almost cushion-like environment for your body so you experience no stress or heavy impact. And even though it’s a low-impact exercise on your joints, it helps burn calories and tone muscles. Swimming at a leisurely rate for an hour can burn up to 600 calories.

Riding a bike is another great low-impact option. The range of motion wouldn’t add pressure to your ankle but will get your heart rate going. Stationary bikes are great in the home or at a gym. Also, investing in an outdoor bicycle may be a easy way to get a workout in while spending time with your three kids. Riding a bike with your family for just 30 minutes a day at a relatively slow pace burns 275 calories.

Yoga is another low-impact exercise option for you to do in the comfort of your home — no equipment necessary. It strengthens and tones your muscles and can also help reduce stress. A combination of low-impact cardio with a yoga routine would really kick start your health transformation.

Don’t forget that a successful weight-loss program combines healthy eating and exercising. Reducing your caloric intake by 3,500 calories a week can result in a steady weight loss of one pound per week. That breaks down to 500 fewer calories a day. Cutting out 250 calories from your diet and burning 250 calories from exercise a day is an easy way to get started.

Continue to stay motivated, JJ, and you’ll be back to healthy weight before you know it.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

Asked by Kate, Cherry Hill, New Jersey

"My 10-year-old is overweight and our doctor suggested he start taking statins. Is he too young to begin this type of medication? Is it even safe?"

Answer:

Strange as it sounds, in rare cases prescribing statins to kids as young as 8-years-old is recommended by the American Academy of Pediatrics.

But certainly, not every child who is overweight needs such treatment.

The academy recommends that doctors use the following criteria when prescribing statins to kids: a child’s LDL level above 160 plus two risk factors, such as being overweight and high blood pressure. Or a child with no risk factors but an LDL level above 190.

Although controversial to some, many experts agree that these cholesterol-lowering drugs are safe, and the benefits outweigh any potential side effects.

The American Academy of Pediatrics looks at it as a preventive measure, hoping to avoid serious health problems later in life. The U.S. has a generation of children developing adult-like health conditions that will put them at high risk for blood clots and heart disease by their mid-30s if parents and doctors don’t monitor it.

That’s one reason, with an estimated one in three of our kids overweight, pediatricians are beginning to track weight and cholesterol levels starting at age 2.

But is medication the only answer? Absolutely not. Parents first need to exhaust all diet and exercise options. Take walks at night or race around the living room to burn extra calories each day. And lead by example. If you make healthy food choices, your kids will pick those habits as well. Small changes can save kids from years of potential health problems. For an overweight child, losing just 5 percent of their body weight can reduce cholesterol levels and prevent the need for medication.

By Jennifer Pifer-Bixler
CNN Medical Senior Producer

One of my favorite television shows is “Intervention.” On the show, people with harrowing addictions are confronted by loved ones with the help of a trained interventionist. Typically, the episodes end with the addicts going to rehab. It's my idea of “must see TV”: trauma, drama and redemption all wrapped into an hour. Most of the time, the people on the show are addicted to drugs or alcohol. But there was one addict with a different story. Josh was a compulsive overeater. In his early 20s, Josh spent his days gorging on fast food and sweets. He weighed nearly 550 pounds and was miserable. Every time Josh walked up the stairs, he felt as if he were going to have a heart attack. Something about Josh really struck me. He had a gentle demeanor. His passion was singing and he had a beautiful voice. When he went away to the rehab, I was really rooting for him. The other night, I caught a follow-up episode on Josh. It's hard to believe what's happened to him.

Josh's story came to mind as I read an unsettling statistic. For the first time, obese Americans now outnumber the merely overweight. According to the Centers for Disease Control, 32 percent of Americans are overweight, 34 percent obese and 6 percent are extremely obese. To put that into perspective, if you are 5 feet 5 and weigh 150 lbs, that's considered overweight. If you weigh 180, that's considered obese. Statistically, women as a whole tend to be a tad more obese then men. As we've pointed out many times, America has an obesity epidemic. Over the years, we've seen a number of carrots and sticks offered as ways to combat to this major U.S. health issue. Some health insurance policies offer discounted gym memberships to help people watch their weight. In New York City, certain restaurants have to post calorie information on menu and menu boards. In Mississippi, lawmakers even discussed proposing a bill that would make it illegal for restaurants to serve obese people. That idea was shot down pretty quickly. Ideas abound. But still the numbers go up. Why? I decided to ask an unconventional expert.

I tracked down Josh. He is doing great. In the past year and a half, he has lost close to 249 pounds. He's now around 300 pounds and is working hard to lose 100 more pounds. I asked him why he thought the number of obese Americans is growing. While he doesn't claim to speak for all obese people, Josh thinks for most of them food is an addiction. "It's a cheap way to stuff down emotions," says Josh. "I used food as a drug so I didn't have to feel." Josh says food for him is like booze for an alcoholic. "I don't think it's a matter of willpower. I could not control the power of food," he says. He couldn't just have one sliver of cake. "I'd eat the whole thing," he says. Like an addict looking for his next fix, Josh says, he use to plan his days around when he was going to eat and what. When he went into rehab, Josh says he had to come to terms with some things about who he is and what he wants. "The number on the scale is just one small part of the story," he says. "The real miracle has come through my spiritual and emotional growth. My goal is to help other people who have been where I was."

I love Josh's story and hope he continues to lose the weight and grow into the man he wants to become. His confidence is soaring. He plans to audition for “American Idol” and “America’s Got Talent.” Josh has become a success story in America’s obesity epidemic. I am curious. Do you think obesity is the result of addiction? Do you think health insurance companies should pay for compulsive eating rehab?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Elizabeth Landau
CNNhealth.com producer

I dreaded those weeks of gym class dedicated to laps around the track. My breath faltered after less than a minute of jogging, and my legs felt stiff. I placed last in every race the instructor made us run. Fortunately, my good friend Ariana sometimes walked with me while the others sped ahead. Having a companion to defy the track requirement made our slow pace seem more like a rebellion: “It’s not that we can’t run, we just don’t want to.”

I began jogging on a treadmill to combat my “freshman 15” – the extra pounds accumulated by many first-year college students when offered a seemingly unlimited supply of cafeteria treats. But I always felt hungry afterwards, and ended up instead with a freshman 20.

Running to lose weight became even more of a burden than running for gym class. I found myself running on Princeton’s rain-splattered sidewalks at midnight because the fitness center had closed and I wasn’t seeing results in the mirror fast enough.

Running became a fun, relaxing activity only recently, after I regained my pre-college weight during my senior year. When no gym instructor was yelling at me, I seemed to find a balance between eating, exercising, studying and socializing and I could finally feel good about pushing my legs to new speeds for longer and longer periods.

I asked exercise physiologist Lauren Williams Korzan, a certified Health Fitness Specialist through the American College of Sports Medicine, what tips she would offer to someone who wants to start making running part of his or her life. Here’s her advice:

* Begin slowly. Start with a walk/run program. Try running for two minutes and walking for four minutes, for a total of thirty minutes. Over time, increase your running time and decrease your walking time. Eventually, you will be able to run for 30 minutes without walking.
* Schedule workouts into your week. It will be easier to turn running into a habit by making it a scheduled priority each week. Aim for three workouts per week.
* Follow a training program. Many running coaches, clubs, and Web sites offer programs for beginners.
* Set goals, both short and long-term. While your long-term goal may be to run a 5K race, your short-term goal may be to run at least three times a week to build endurance.
* Keep a log. A running log helps to track your workouts and will allow you to see how far you've progressed.
* Listen to your body. If you're feeling tired or sore, take a rest day or substitute a lower-intensity workout. Cross training with swimming, biking or an elliptical machine will prevent placing too much stress on the same muscles and help to reduce your risk of injury.
* Wear proper footwear. A good pair of running shoes can make running easier and keep you injury-free.
* If you're having trouble with motivation, listening to music or running varied and scenic routes may help. Be aware that running outdoors with headphones may not be safe.

Have you learned to love an activity that you previously didn't enjoy? What tricks helped you to begin enjoying it?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

Asked by Sydney, Fort Wayne, Indiana

"I heard that having a potbelly is the worst type of fat to have. Any truth to that?"

Answer:

Thanks for the question, Sydney. There’s been a lot of research trying to determine whether abdominal fat is, in fact, different from fat in other areas of our body. The answer is yes. We now know belly fat is the most dangerous type to have because it’s actually more biologically active, which causes calcium build-up in our arteries. This is significant because often people in a normal BMI range are still carrying extra weight in their stomachs but may not realize they’re at an increased risk for cardiovascular disease. Also, research recently published in the New England Journal of Medicine found that people with belly fat have a higher risk of dying compared to their peers without a spare tire.

So now the question is how do you figure out whether you’re at risk? Instead of just looking at the number on the scale, keep track of something known as your waist-to-hip ratio. Here’s how to do it: Measure the circumference around your belly button and then around your hips. You want your waist measurement to be smaller than your hips and thighs. The smaller the better. In the study I mentioned, researchers say a 2-inch increase in waist circumference raises mortality risk by 17 percent in men and 13 percent in women, regardless of BMI.

On a positive note, stomach fat is really the easiest to lose. Making a few tweaks to your diet routine and more importantly, if you get moving, you’ll notice your stomach fat slim down in no time at all. Exercise is still the best way to maintain long-term healthy weight. Try to fit in some sort of daily activity. Don't have an hour? No problem. Split up activities into small amounts throughout your day and reap the same benefits. Also, if you have weight to lose, the worst thing you can do is stop eating. The best way to get your metabolism moving and lose weight is to eat frequently - small meals every four to five hours. Also, never skip breakfast. Studies show people who eat breakfast lose more weight and burn more calories than those who do not.

So bottom line, Sydney, pay attention to not only how much you weigh, but where the fat is settling in on your body.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

Asked by Lillian, Washington, D.C.

"I go to school and work and never seem to have time to cook healthy meals or fit in a workout routine.  Can you give me some advice on how to get a program started?"

Answer:

Lillian, I can vouch firsthand that with a busy schedule, healthy eating habits and exercise routines are often the hardest to keep up 
with. 

One thing we know is that vegetables are one of the best foods for us to eat. They are filling, and packed with vitamins and nutrients. 

Look for vegetables at the store that are easy to prepare: pre-washed salads, carrots, grape tomatoes, celery. 

 One thing my family does is create vegetable snack-packs.  We get zip-lock bags and mix up the vegetables so they are easy to grab and eat on the road or bring for lunch.   Also, give grilling a try! It is an easy way to add a healthy, gourmet touch to dinner. Season vegetables-like asparagus, mushrooms, green peppers-with low-sodium seasonings and grill for about 5 to 10 minutes.

As for exercising, since your time is limited, try to find an activity that you can do socially while gaining health benefits.   One example is joining a dance group.  You can burn up to 500 calories dancing an hour.   Have a dog? Look for dog-walking group in your area.  It’s a great way to meet people, and help you..and Rover get in shape. 

The bottom line is you have to make health a priority.  Even if you have just 30 minutes a day of free time to exercise -make it happen! You will end up having more energy for your daily tasks at work and school.  Good luck, Lillian!