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New diet pill is no 'Alli' in fighting flab

Just how good is a weight-loss pill if it takes a reduced-calorie, low-fat diet and exercise to make it work? About 50 percent better than no pill, says Dr. Gary Foster, director of the Center for Obesity Research and Education at Temple Universi...

Just how good is a weight-loss pill if it takes a reduced-calorie, low-fat diet and exercise to make it work?

About 50 percent better than no pill, says Dr. Gary Foster, director of the Center for Obesity Research and Education at Temple University in Philadelphia. He wrote the first chapter of "Are You Losing It?" a how-to booklet about sustainable weight loss and Alli, the 60-milligram over-the-counter version of orlistat, the weight-loss drug sold by prescription since 1999 under the brand name Xenical (120 mg capsules). Alli blocks the absorption of fat so that you lose about 50 percent more weight with it than without it, all else being equal.

Alli (pronounced AL-eye) became the first non-prescription diet pill approved by the U.S. Food and Drug Administration this year and should be on the shelves of grocery stores, pharmacies and mass-market outlets this summer, but if you are waiting for a magic bullet to lose weight for you, Alli isn't it.

A low-fat diet with 15 grams of fat or less per meal is recommended with Alli, and you can get that much fat in a single dish of ice cream, points out Janet Hendrix Duncan, former president of the Fort Worth Dietetic Association. A lot of fat is hidden - in fact, the only foods we eat with no fat are plain fruits and vegetables. Even broccoli can be high-fat with enough cheese on it, Duncan says.

Information on the fat content of common foods is packaged with the drug.

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"Weight loss is about taking time for self-care," Foster says. "It's about changing your attitude, your behavior and your lifestyle. You have to start from a position of self-worth: I'm worth taking care of. My health is worth it, a healthy weight is worth it. Losing weight is a positive thing you do for yourself, not a punitive thing to make up for overeating."

"Are You Losing It?" is widely available for $5.99.

We asked Foster about Alli:

How does Alli work? Alli is a fat blocker. It works by decreasing the amount of dietary fat that is digested. The 60-mg. orlistat capsules are meant to be taken with already low-fat, low-calorie meals, up to three times a day to prevent enzymes in the intestines from breaking down some of the fat calories you take in. If the fat is not broken down, your body cannot absorb it.

Does Alli have side effects? Yes, Alli blocks the absorption of fat, and that fat is passed out of the body in stools, so it can cause some gastrointestinal side effects, including diarrhea and cramping, especially if you eat a large amount of fat at one meal. (In fact, you might want to start Alli while you're at home: The book warns that when you eat too much fat, effects may include loose or more frequent stools that may be hard to control or gas with an oily discharge.) But there is some good news, says Foster: The drug works only in the gastrointestinal tract so it does not cause sleeplessness, jitters or increased heart rate, as some weight-loss drugs do.

How much can I lose with Alli? It depends on your diet and exercise, but with Alli, Foster says, you will lose about 50 percent more than you would without it. That is, for every 10 pounds you would normally lose, Alli will help you lose five more. If you are on a diet to lose 10 pounds in one month without the medicine, you should lose 15 with it.

What can I do to maximize the benefits of Alli? Write down everything you eat, and calculate how many fat grams each meal contains. A low-fat meal should have 15 or fewer fat grams. Most of us vastly underestimate how much we eat.

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