Side effects of Alli, cost worth considering

Two years after giving birth to a healthy baby, Jessica Davis decided it was time to lose those last stubborn "baby weight pounds."

She had tried other diets, but 15 extra pounds refused to budge. After learning of Alli (pronounced "ally"), the first FDA-approved diet pill cleared for over-the-counter sales, she decided it was time for something new.

"I really didn't have a lot of weight to lose, maybe 10-15 pounds to get me back to my pre-pregnancy weight," said the 25-year-old Mendenhall resident. "After hearing about Alli, I decided to see if this would jump start my weight loss."

Manufactured by GlaxoSmith Kline, Alli is a less potent form of the prescription drug orlistat. The drug previously was marketed in 1999 in prescription form by Roche Holding AG under the brand name Xenical, which had limited success on the market.

GlaxoSmithKline's expectations for Alli are much higher than those for Xenical. The company is spending millions marketing the drug in television, radio and print ads and expects to net at least $1.5 billion in annual sales.

While the impressive media hype has created strong consumer interest, physicians, pharmacists and dietitians are balancing the marketing spin with some words of caution. Most notably, health officials argue the drug's high cost and limited effectiveness may not be worth its unpleasant side effects.

Brandi Reed, pharmacist at Target's I-55 North store in Jackson, said Alli works by blocking enzymes that digest fat, which prevents the body from absorbing about one-fourth of the amount of fat that is eaten. The undigested fat is then excreted from the body, creating side effects that can include diarrhea and uncontrollable bowel movements.

"Studies have shown that those who combined the use of Alli Diet Pills with diet and exercise only lost about three pounds more than people who only dieted and exercised. That is not a lot of weight when you consider the side effects and the relatively high cost of the drug."

Dosage instructions warn that to be effective, Alli must be taken three times a day. The pills are projected to cost $1 to $2 per day, with no insurance coverage since they are over-the-counter medications. Reed said 120 capsules cost $72.99. There's also the option of purchasing 60 capsules for $49.99 or 90 for $59.99.

Reed said another serious side effect of Alli besides gastrointestinal upset is interference with the body's absorption of some vitamins. Anyone who takes Alli also should take a daily multi-vitamin, Reed said. Customers who ask her about the drug's side effects also get additional advice.

"The company states that some of the more unpleasant side effects may be lessened if you stick to a diet containing 15 grams of fat or less," said Reed. "If you follow a low-fat diet along with exercise, chances are you will lose weight and not need the pill in the first place."

University of Mississippi Medical Center dietitian Jana Milam urged those considering the use of Alli to understand that the new drug is not a "magic bullet." Milam said the success of Alli or any other diet pill is contingent on implementation of a healthy lifestyle that includes a well-balanced diet and exercise.

"Despite some of the reports and sensational headlines, the road to permanent and long-lasting weight loss is not through a pill or any specific 'magic' diet," said Milam, who counsels UMC patients with diabetes and weight issues. "A low-fat diet and regular exercise is the only real way to lose weight and keep it off."

Leaders of UMC's Weight Management Clinic like Dr. Annette Low and clinical psychologist Karen Grothy urge patients to follow Milam's advice to diet the regular way. The clinic promotes a three-pronged approach in its doctor-supervised program that includes proper nutrition, behavioral changes and exercise.

"Any time a drug like this goes over the counter, it gives false hope to those who think there is a quick fix to weight loss," Grothy said. "This is not an unsafe drug, but it does not come without serious side effects. It is definitely not the miracle cure for weight loss."

Although Alli may be helpful for a small number with no history of weight problems, the drug's advertisements may be misleading for those who don't "read the fine print," Grothy said.

"Alli may prove effective for certain people if they include life-style changes into their daily lives," she said. "What consumers fail to realize is that taking a diet pill will not lead to permanent weight loss. Unless someone undergoes a complete lifestyle makeover that includes implementing proper dietary and exercise habits, the weight loss is temporary and will come right back once the pills are all gone."

Grothy and Milam agreed someone taking Alli initially could lose weight because the body will not absorb all of the fat that is eaten. This may cause the person to stop taking the drug after an optimal weight is achieved. Because dietary changes were not made, the body will soon absorb the fat that Alli helped reject, causing weight to return to its previous level.

"If there was a pill that caused everyone to lose weight in a sensible manner, we wouldn't need any other weight-loss programs," Grothy said. "Unless you look at weight loss as a slow process that must include a proper diet, regular exercise and lifestyle changes, you are not going to achieve the results that you want."

As for Davis, she has lost seven pounds in three weeks and is pleased. Side effects have been minimal, she believes because she followed the company's recommended diet plan and has kept fat intake to a minimum.

"I wouldn't say that Alli is for everyone, but it has given me the help that I needed to lose weight," Davis said. "I think it can be a successful method if you follow all of the directions and realize that there might be some side effects Alli if you don't. And keep your expectations on a realistic level. I think that's the key to any weight-loss plan."