Revisiting Over The Counter Diet Pills

January 2012

I recently came across a video clip of a CBS Early Show episode I participated in a few years ago about the over-the-counter (OTC) diet pill Alli a branded version of the prescription drug Xenical (Orlistat).  (see below)  Since weight loss makes its way to many new year’s resolution lists I thought this would be a good time to revisit the topic.

To give you a little background in 2007 the FDA approved Alli which packs half the strength per dose of its prescription counterpart Xenical. This was the first time the FDA approved an OTC weight loss pill. The FDA’s approval provided a “safe” and scientifically backed alternative to non-FDA approved OTC diet pills. The agency approved Alli in light of the data available on Xenical’s safety and efficacy.  

Alli is said to result in an additional 50% weight loss over diet modification and exercise alone. Studies on the original Orlistat indicated a 5-10% reduction in body mass in one year. The drug also has the potential for use as a preoperative weight reduction tool for bariatric or gastric band surgery.

Basically the way it works is that this drug interferes with the digestion and absorption of fats so they essentially pass through your system unchanged. Since Alli interferes with the absorption of fat it also interferes with the absorption of fat soluble vitamins and essential fatty acids.  Therefore it is advised to take supplements at least 2 hours away from the Alli.  Even though the pill is sold over the counter at half the prescription dose Alli continues to carry the same side effects - namely gastrointestinal disturbances such as loose bowels bowel urgency and oily stools.  
As I noted in the video it's not a magic pill that lets you get away with a burger and fries every day because the excess fat in the diet would increase the severity and unpleasantness of the side-effects.

It is recommended to not eat more than 15 grams of fat per meal while on Alli. To put that into perspective 15 grams of fat is found in a TB of olive oil or a 4 oz beef burger or a 2 egg omelet cooked in a pat of butter. So if you have a burger and salad a no oil dressing would have to be used. If you had an omelet no other fat source can be consumed with that meal. You would have an omelet and fruit but no bacon or buttered toast. So the threat of oily stool will help you stay compliant with dietary modifications which help support the weight loss.

There have been reports of Alli's effectiveness but one should discuss taking it with a qualified health professional due to the side effects and known risks – such as liver damage.  When the prescription version Orlistat first came out there were patients that I was working with who had to stop the drug because of these prohibitive side effects.  For one client with a history of chronic constipation the drug was effective.  

While Alli may serve as a beneficial adjunct to a lifestyle and diet modification program when other more traditional weight loss programs fail I remain concerned about the potential for abuse by people with eating disorders.  Some of the pre-packaged plans on the Alli web site encourage gradual adjustments to one's lifestyle and diet something I've always encouraged.  More importantly I've always considered non-natural solutions (and even many natural solutions) to be a last resort after diet options alone have been exhausted. Other over the counter diet pills exist but should be used with caution as they are not required to be approved by the FDA and are not rigorously tested for safety and efficacy before released to market.  

So in the end I encourage modifying lifestyle and diet along with supportive supplements first. Typically this is an effective and doable strategy provided one is patient and has the support of a well qualified practitioner and family members. If these methods fail scientifically backed diet pills may be tried under the guidance of a qualified health practitioner. It’s important to emphasize that there is no magic pill and even pharmaceutical adjuncts require lifestyle diet and support strategies as well for ultimate lifetime success.