A Happy, Healthy New Year?

From the declining popularity of plastic surgery reality TV and the dawn of implantable contact lenses to a scaling back of the low-carb craze, a beefing up of basic physical fitness, and an influx of new drugs to treat such vexing conditions as diabetes and the blinding eye disease macular degeneration, 2005 may just prove to be a happy and a healthy new year.

That's why WebMD asked leaders in many fields to get out their crystal balls and tell us what's in store for 2005.

Here's what they had to say:

The Skinny On Obesity Research

Obesity will continue to be a big topic in 2005, experts tell WebMD. "There will be no one, big, blow-out, breakthrough coming, just more information that will support the idea of treating obesity," says Louis J. Aronne MD, a clinical professor of medicine at Weill Cornell Medical College in New York and president of the North American Association for the Study of Obesity. Though he is not sure there will be any new drugs approved to treat obesity in 2005, there will be some activity for Acomplia, a weight loss drug that also helps people quit smoking.

"This drug will be submitted to the federal Food and Drug Administration for approval in 2005," he says. "I don't know if the company will submit it for smoking [cessation], diabetes, or another condition, but it will be submitted within next few months." Looking further down the road, he says, "Acomplia is way ahead of everything else, but there will be more studies and trials of other drugs including AOD 9614, an experimental drug which seems to cause weight loss without affecting appetite." Aronne says the trend toward weight loss surgery will continue to increase. "It's the most effective treatment available, and I really think another trend is that people will want to go to specialty obesity surgery centers to undergo it."

Nips 'N' Tucks In The New Year

In 2005, several deeper and longer-lasting wrinkle fillers will join the growing list of already approved injectables, predicts plastic surgeon Mark L. Jewell, MD, the president-elect of the American Society for Aesthetic Plastic Surgery. This may include Restylane SubQ to bulk up the cheeks and chin. It requires a larger needle and deeper injections that go below the skin layers and may last longer than currently available fillers. "Botox will remain front and center, although the FDA may crack down on imported substances given the Florida situation." In late November 2004, a Florida doctor allegedly injected himself, along with his girlfriend and two patients, with an unapproved botulism toxin marketed as a less expensive version of Botox. All four people were paralyzed as a result.

2005 may also bring about a new option in breast implants: cohesive gel implants. These are made of cohesive silicone gel, are leak-resistant, and have the consistency of a gummy bear. "By the end of next year, we may have one or two available, which is good news," he says. These implants are made to last longer and maintain a more realistic shape.

There may also be some progress in the development of noninvasive alternatives to liposuction, he says. Two such alternatives are being studied: Ultrashape and LipoSonix, both of which use ultrasound to "melt" localized fat deposits.

But don't start booking your appointments just yet. "I don't think either will be out in a packaged version in 2005," he adds.

In addition, plastic surgeons will make strides in refining the optimal technique for body lifts after weight loss surgery. Many people opt to undergo a series of procedures after weight loss surgery to do away with excess skin. Jewell also thinks that the American public may be moving away from the dramatic alterations they have witnessed on plastic surgery reality television shows as they embrace subtler changes over extreme makeovers, both personally and as viewers.

Envisioning 20/20 Vision

"There's no question about it: The first sign of mortality is diminished vision," says ophthalmologist Cary Silverman, MD. And baby boomers will not take this lightly — the good news is they won't have to because of new implants for your eyes. "These focusing implants are one of the hottest topics today," he says. The FDA has already approved one such implantable lens, the Verisyse lens, and others are in the pipeline.

"In the past, we only used implants to treat cataracts, but now we are using them for better focusing," he tells WebMD. "Some people will still be wearing contact lenses," he says. "Just as not everyone gets LASIK eye surgery, not everyone will do this, but it's certainly a lot easier and a lot more convenient than traditional contacts." These lenses are helpful for people who are not good candidates for LASIK because they have extreme nearsightedness or their corneas are too thin.

Many doctors will also begin to further refine vision with LASIK after these lenses are implanted, he says.

Bidding Goodbye To Blindness

In late 2004, the FDA approved Macugen for wet age-related macular degeneration, a disease that affects the central vision. This drug helps preserve vision and limit progression of wet AMD to legal blindness. Another such drug, Retaane, is also up for FDA-approval. Macular degeneration is deterioration or breakdown of the macula, a small area in the retina at the back of the eye that allows you to see fine details clearly, read and drive. There are two types of macular degeneration — "dry" and "wet." The condition almost always starts as the dry form, but about 15 percent of those with dry AMD eventually develop the wet form, which progresses faster and therefore causes more severe vision loss. Macular degeneration is the leading cause of blindness for those aged 55 and older in the United States, affecting more than 10 million Americans, according to the American Macular Degeneration Foundation.

Cancer Made Easier

"We will start seeing more targeted and less toxic therapies in 2005," predicts Robert Morgan, MD, a physician in the division of medical oncology & therapeutics research at the City of Hope Comprehensive Cancer Center in Duarte, Calif. "This has been exploding so much in last five years, and we will see much more in the next 12 months."

Unlike standard chemotherapy drugs, which attack good and bad cells alike, targeted therapies attack only specific cancer-causing cells. For example, the already approved leukemia drug Gleevec blocks a protein, called BCR-ABL, which is responsible for the overgrowth of mature and immature white blood cells in the bone marrow and blood of people with a certain type of leukemia. Another approved example is the colon cancer drug Avastin, which shuts down the blood vessels that feed tumors, effectively starving the tumor.

"These therapies will continue to be combined with traditional therapies, leading to better outcomes and fewer side effects." And doctors, especially oncologists, will start to embrace some alternative therapies, as they may no longer have a choice. "We are going to have to try to incorporate what patients are doing along with traditional programs," he says.

Fad Diets Fade

Wellness expert Ann Kulze, MD, the author of Dr. Ann's 10-Step Diet: A Simple Plan for Permanent Weight Loss and Lifelong Vitality, is pretty sure that the low-carb craze will wane in 2005, and recent statistics back her up. The percentage of Americans on low-carb diets has dropped by almost half to 4.6 percent at the end of September 2004 from 9 percent in January, its peak, according to data from the NPD Group Inc., a Port Washington, N.Y.-based marketing-research company. "Their popularity is dwindling," she says. "There will be sustainers, but without a doubt there will be many less newcomers to the low-carb approach."

This doesn't mean that the bankrupt bakers of Twinkies and Wonder Bread or any other starchy snack food who lost their shirts as a result of the low-carb craze will be back in the black, but be on the lookout for detractors who brazenly sport T-shirts that read "I eat carbs."

However, "part of this trend is here to stay, and that's the avoidance of the great white hazard — white potatoes, sugar, white flour products, and white rice," Kulze says. "There is just so much rock-solid data to tell us that they increase appetite, promote weight gain, and are not good for health."

So what is?

"More and more the public is on board with the fact that the same strategies that embody healthy eating also help with long-term weight loss — namely increased fruit and vegetable intake," she says. "We are moving away from fad diets, and the public is recognizing that weight and health are inextricably linked and that the best way to do this is to make permanent dietary and lifestyle changes that improve health as well as decrease waistlines."

Fitness Forecast

Eric von Frohlich, a group exercise instructor at Equinox in New York City and the chief exercise officer of roadfit.com, an outdoor training group fitness organization, says this year, "people will be getting away from gadgets and getting back to basics including boot camps, squats with shoulder presses, push-ups, jumping jacks, and calisthenics." In 2005, he says, "it will not be not about classes that are trying to be super-creative. There will be no step or music-oriented, dancey stuff anymore," he says.

The American Council on Exercise agrees. In their 2005 predictions, this group also forecasts a "back to the basics" approach including time-efficient workouts and core strengthening.

Looking into his crystal ball for WebMD, von Frohlich says, "people are turning away from big gyms and going back to smaller studios and outdoor training." Specifically, "swimming, biking, and running triathlons are exploding and will continue to do so in the new year," he says, crediting Lance Armstrong for the marked increase in cycling. This famous cancer survivor won a record sixth Tour de France tournament in July 2004. So is it the end of the yoga movement? "Yoga and Pilates will always have a place," he says. "It is still at a peak, but it won't be as feverish in 2005 as it was for the last couple of years."

And "there will be a fitness upswing in kids aged 11-17 year old," he predicts. ACE also portends an increase in family participation in outdoor fitness activities.

Von Frohlich also says celebrity-endorsed fitness programs are passé as most non-celebrity fitness seekers do not have the same time, money, or motivation that celebrities do and are instead opting for fitness that fits into their lifestyles.

Catching Zzz's

The recent approval of a new, longer-lasting sleeping pill, Lunesta, "will open up the possibilities of chronic treatment of insomnia," says Timothy Roehrs, PhD, director of research at the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit. "This drug is effective up to six months and will change the prescribing habits as doctors will feel more comfortable prescribing it for longer," he says. By contrast, current market leader Ambien is only prescribed for seven to 10 days. With Ambien, many insomniacs get to sleep, but they wake up in the middle of the night. However, a controlled-release form expected in 2005 may help better maintain sleep.

Indiplon is also nearing the market in two formulations, fast-acting and "modified release." WebMD recently reported that two other sleeping pills are also in the pipeline and nearing final stages of studies. They include TAK-375 from Takeda, a Japanese firm, and gaboxadol from the Danish firm H. Lundbeck in partnership with Merck.

Advent Of Arthritis Alternatives

The withdrawal of the Cox-2 drug Vioxx by Merck & Co in 2004 and recent disclosures that other nonsteroidal anti-inflammatory drugs may also raise risk of heart attack and stroke will continue to evolve and change the way aches and pains of some forms of arthritis are treated, says John H. Klippel, MD, president and CEO of the Arthritis Foundation. The brouhaha "has created an interesting dialogue about risks and benefits, and every time a consumer chooses to take a drug, they have to understand the risks and accept them."

Moreover, newer Cox-2 drugs are waiting in the wings, he says. "The fact that we have now had a discussion about the existing Cox-2 drugs in 2004 will make it difficult for any of the newer generation drugs to be approved in 2005."

He also predicts an expanding role for anti-inflammatory medications called biologic drugs, such as tumor necrosis factor (TNF) inhibitors, which block TNF, a protein that plays a key role in inflammation and joint damage.

But that's not all the new year will bring for the millions of people with arthritis. "I think it's likely we'll see new approvals for Rituxan and an introduction of abatacept in 2005 for [rheumatoid arthritis]," he says. Abatacept is part of a new class of medications known as co-stimulation modulators that block the cells of the immune system that cause inflammation and release inflammatory chemicals. Rituxan is a cancer treatment for use in lymphoma and works by targeting and depleting the B-cells also known to play a role in inflammation.

Flu Fears Flourish

"We are really worried about the bird flu but can't make any predictions [about it]," says Dave Daigle, a spokesman for the CDC in Atlanta. "I think the avian [bird] flu has the potential to be a big story in 2005." As it stands, officials at the World Health Organization warn that millions of people may die if the bird flu virus spreads among humans. Spread would take very close contact with infected birds or another infected human. So far, there have been only 44 known cases, resulting in a chilling 32 deaths in Thailand and Vietnam. It also led to the slaughter of millions of poultry across the region.

In light of the highly-publicized shortfall of flu vaccine this year, Daigle says he is also worried about a flu epidemic. "The peak takes place after January, and we have seen a late peak in past years, and we are hoping that people who didn't get a shot will go out and get one now," he says, noting that some states and cities may have an excess.

For Skin Care, Less Is More

"For 2005, I expect to see more noninvasive procedures for skin rejuvenation that have less downtime and less recovery," New York City dermatologist Ariel Ostad, MD, an assistant clinical professor at the New York University School of Medicine, tells WebMD. "A good example includes Thermage skin tightening for eyelids, jowls, neck, arms, and abdomen as opposed to liposuction with more downtime and recovery." Thermage is a noninvasive technique that uses radiofrequency waves to tighten tissues while cooling the skin to minimize redness. Moreover, "I also anticipate lasers with much less downtime than are currently in use."

Diabetes Decisions Anticipated

John B. Buse, MD, PhD, chief of the division of general medicine & clinical epidemiology and the director of the Diabetes Care Center at the University of North Carolina School of Medicine in Durham, N.C., expects to see two new drugs approved for diabetes in 2005. "Exenatide will be approved for type 2 diabetes, and I expect that Symlin may be approved for type I and type 2." Symlin is a man-made version of human amylin, a hormone secreted with insulin, while exenatide is a first-in-class drug that works by improving glucose control among people with type 2 diabetes who are not using insulin and are not achieving target levels with diet and oral medications.

"The only thing holding these drugs back is that they have to be injected, and there is a bias in the mind of patients and providers that injections are difficult, but I am looking forward to them becoming available."

Sources: Louis J Aronne, MD, clinical professor of medicine, Weill Cornell Medical College, New York; president, The North American Association for the Study of Obesity. Mark L. Jewell, MD, president-elect, American Society for Aesthetic Plastic Surgery. Robert Morgan, MD, division of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, Calif. Ann Kulze, MD, author, Dr. Ann's 10-Step Diet: A Simple Plan for Permanent Weight Loss and Lifelong Vitality. Eric von Frohlich, group exercise instructor at Equinox, New York; chief exercise officer, roadfit.com. Timothy Roehrs, PhD, director of research, Sleep Disorders and Research Center, Henry Ford Hospital, Detroit. Dave Daigle, spokesman, CDC, Atlanta. John H. Klippel, MD, president and CEO, Arthritis Foundation, Atlanta. Ariel Ostad, MD, assistant clinical professor, New York University School of Medicine. John B. Buse, MD, PhD, chief of the division of general medicine & clinical epidemiology; director, Diabetes Care Center, University of North Carolina School of Medicine, Durham, N.C.

By Denise Mann
Reviewed By Brunilda Nazario, MD
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