Not a miracle drug, but alli has its place

Alli is another soldier in the battle against obesity. When this compound was available under the name Xenical (orlistat), prospective users had to get a prescription for it. In theory, this would have included a talk with your physician about potential side effects. Now, with alli, you have a version of orlistat that is available over the counter. As an OTC product, alli was tested for safety and efficacy before being released on the market. This being said, there is an increased level of self-reliance when a product can be purchased and used at will.

Xenical and alli work by inhibiting the action of lipase, a key fat-digesting enzyme that breaks apart the fat in the food we eat prior to absorption. When lipase is unable to work, these fats remain in your gastrointestinal track and are eventually eliminated. The dose determines the effect. With Xenical, approximately one-third of the fat consumed is not absorbed. With the OTC version, alli, only one-quarter of dietary fat is affected.

I am not a big fan of such drugs, but I recognize that they might be appropriate when morbid obesity (weighing more than 100 pounds over your recommended weight) interferes with normal activity and physiological functions, such as difficulty in breathing when one lies down, or when the obesity is directly related to diseases, such as hypertension or diabetes. I have some concern for people who might turn to alli as a quick-fix way to drop a few pounds. The main reason for my concern has to do with the adverse effects caused by the undigested fat passing through the intestines.

According to Xenical's Web site, these effects include "gas with oily discharge, an increased number of bowel movements, an urgent need to have them, and an inability to control them, particularly after meals containing higher amounts of fat than are recommended." This comes from the company selling the product. Because fat is the provocateur, eating a low-fat diet minimizes the side effects. There will definitely be a punishment factor for anyone who might consider such a drug as a license to eat more fat.

For anyone considering alli or orlistat, I encourage you to read all the information before you start. Once you purchase an alli starter pack, you can access a free online counseling service at http://www.myalli.com and receive a personalized action plan and answers to your questions.

Safety of new weight-loss drug is questioned

A new over-the-counter weight-loss drug called Alli may give people with eating disorders another tool to harm themselves, local therapists fear.

Alli — pronounced "AL-eye" — is the only weight-loss medicine on the market approved by the federal Food and Drug Administration. It's half the dose of the prescription drug orlistat, trade name Xenical, which is used to fight morbid obesity.

Dr. Randall Flanery, head of the Eating Disorders Program for the St. Louis Behavioral Medicine Institute, says the new drug is ripe for abuse because young people with eating disorders find the side effects of intense diarrhea and other gastrointestinal problems that empty the digestive system inviting.

People who use diet products to bolster their eating disorders "… tend to take them at much higher dosages than recommended, as much as 10 times," Flanery says. "It's analogous to laxatives. People with eating disorders take 10 to 50 (laxative pills) at a time. They become dependent and take higher and higher dosages."

Another danger is that the medicine is approved by the FDA "… and people will believe that because it's over-the-counter and FDA-approved, it must be safe," Flanery says. "It's not."

The drug should be kept behind counters and monitored for distribution to make sure that at least teens don't have access to it, Flanery says.

What is it?
The FDA approved Xenical nearly 10 years ago. It limits the absorption of fat so that the fat doesn't enter the bloodstream as triglycerides. Triglycerides are used for fuel and are stored in fat cells. In excess, they clog the blood vessels and help cause heart attack, stroke and organ failure. They can elevate because you eat too much fat or because you have a disease such as diabetes.

The FDA approved Alli in February at 60 milligrams. (Prescription-strength Xenical is sold in 120 mg capsules.) The manufacturer, GlaxoSmithKline, says in its advertising literature that the drug can increase weight loss by 50 percent if it's used along with a reduction of fat intake and an increase in exercise.

But you can experience oily diarrhea, flatulence and other intestinal side effects.

Not unanimous
A weight-loss specialist says anything Alli can do can be done for a tiny fraction of the cost by medications that are easier to purchase by minors.

"There are a lot of cheaper ways to get diarrhea," says Dr. Samuel Klein, head of the Weight Management Program at Washington University. "This medication is $60. …" That's for 90 pills.

"It's half the dosage (of the prescription version), and the manufacturer is marketing it responsibly as something that needs a change in lifestyle to work," Klein says.

Also, he says, the gastrointestinal problems are bothersome enough that even someone with an eating disorder wouldn't want to face them, especially with easier alternatives.

Eating disorders
Flanery's concern is that people with anorexia nervosa and bulimia — about 1 percent of the female population under 24 and a growing number of men — use a bunch of tricks to get thinner.

The tricks include faking eating, taking laxatives, purging (vomiting a meal), isolating themselves and taking amphetamines to reduce appetites.

Debbi Kuehnel, a counselor and owner of the Eating Disorder Recovery Center, wants the drug to be taken off the market. People with eating disorders are as prone to trends as anyone, and Alli's newness could be its attraction, she says.

"We already had a client who stole a bottle," Kuehnel says. "She took 10 pills. They don't care about the side effects.

"Putting this drug on the market was ridiculous," she says. "The ads say eat right, exercise and change your lifestyle and use the drug. You'll lose weight if you eat right, exercise and change your lifestyle; you don't need the drug. The prescription dose was meant for people who are morbidly obese; there's no need to make it over-the-counter."

Local response
The four largest chain pharmacies in the area restrict the sale of Alli by locking it in cases, selling it from behind pharmacy counters and by not selling it to anyone under 18. But spot checks throughout the area found the measures inconsistent from store to store within the same chains.