Amid growing concerns about the spreading problem of overweight and obesity in Western nations, the promise of Alli, a U.S. Food and Drug Administration (FDA)–approved diet pill newly available without a prescription, is giving hope to many.
Alli is not a new drug. It is the brand name of orlistat (tetrahydrolipstatin), which has been marketed by Roche as Xenical. Roche claims that “Xenical is the number one prescription weight loss medication, approved for use in adults in over 50 countries worldwide.” Orlistat disables lipase, an enzyme found in the digestive tract, preventing it from breaking down dietary fat that is normally used or stored for energy in this smaller form. Instead, some of the fat continues undigested through the intestines and is then eliminated. This process does have unpleasant intestinal side effects for some users, which (according to the Xenical Web site) “may include gas with oily discharge, an increased number of bowel movements, an urgent need to have them, and an inability to control them.” Perhaps predictably, the drug became fodder for television’s late-night satirists, and public interest in taking the diet pill waned.
Drug giant GlaxoSmithKline (GSK) seems confident that reactions to Alli, which is essentially a half-dose (60 mg) version of Xenical, will be more positive. GSK has been promoting Alli heavily in magazines and on television, encouraging presales of the drug in stores and online well before its June 15, 2007, release.
Advertisements direct consumers to helpful information on the Alli Web site. They are quick to point out that “there is no such thing as a magic pill for weight loss” and encourage dieters to exercise and eat smaller portions with less fat. They provide a list of warnings for people with certain health issues (diabetes, thyroid disease, kidney stones, gallbladder problems, pancreatitis, organ transplants or trouble absorbing food), and advise against taking the drug while on blood-thinning medication or cyclosporine.
But for those who do not have any of these contraindications, they say, Alli may provide “a comprehensive program that works in conjunction with a sensible diet to promote weight loss.” This diet includes less than 15 grams of fat per meal, which is about equal to an average cheeseburger (no fries or milkshakes) or three fried chicken strips. In addition to reducing fat calories and taking a pill three times daily, the consumer is encouraged to become more active and to take a multivitamin to counteract the loss of fat-soluble vitamins (including A, D, E and K). The starter pack includes more than 200 pages of material to guide consumers through the use of Alli. It then leads them back to the Web site and provides a code to access an extensive online support program with weekly monitoring, personalized e-mails on dietary nutrition, shopping lists, professional advice, plus online journals and interaction with other Alli users.
A video on the site euphemistically describes the possible gastrointestinal surprises as “treatment effects.” The narrator suggests that some users think of these “as a way to become more aware of what they eat. . . . Minimizing treatment effects can be an incentive to keep from eating too much fat.” So the positive spin is that a dietary slip-up—eating an extra tablespoon of ranch-style dressing, for example—could prompt a seriously embarrassing event, thereby encouraging the user to be more diligent in the future.
Not everyone is so positive about orlistat. The consumer group Public Citizen expressed concerns in a petition to the FDA, citing studies that indicate a link between Xenical and the development of precancerous colon lesions in rats. Despite this, the makers claim it is the most extensively studied weight-loss drug on the market and is safe when used as directed.
But consumers are notorious for not following directions. And there are valid fears that Alli may be used (or misused), with disastrous consequences, by those who are not a healthy match. We do need essential fats in our diet, and this drug does not discriminate between good fats and bad fats. Others believe it will not make a difference to weight loss, as people will pop the pills to justify eating more fat. This could prompt a continuous cycle as the consumer consumes more fat, only to become dependent on the drug to maintain current weight.
Alli may well help those who follow the extensive recommendations. Those willing to change their eating habits and lifestyles will most likely be aided by the online support. The extra boost offered by the drug might help them shed those few extra pounds.
GSK hopes the public will be willing to pay for a pill that, when used as directed, eliminates just over 100 calories per day of ingested fat—the caloric equivalent of about five teaspoons of Haagen-Dazs ice cream or about an ounce of McDonald’s french fries.
But if consumers are willing to eat lower-fat meals in smaller portions and to exercise while using Alli, might it be simpler and cheaper to just scrape off that extra hundred-calorie dollop of mayonnaise than to take the pills? Eliminating a few extra calories before ingesting them would certainly seem a safe, time-tested alternative that offers only positive “treatment effects.”
ALICE ABLER
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FOR MORE INFORMATION:
www.webmd.com/content/Article/83/97624.htm?pagenumber=1www.myAlli.com
http://www.citizen.org/publications/release.cfm?ID=7423
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