A Short Page From My Alli Diary

by alisa belkins

 In February of this year, the Food and Drug Administration (FDA) approved the first ever over-the-counter weight loss drug, orlistat (Alli). The drug was first approved in 1999 (under the trade name Xenical) for prescription use only - sales didn't take off the way they were expected perhaps due to poor side effects. Now that the drug is available in an over-the-counter form, it has been flying off the shelves. Part of the drug's success may be attributed to a consumer advertising campaign by the drug's maker, GlaxoSmithKline. According to the company, the average US adult has seen more than ten advertisements for Alli and more than two million (!) prescriptions have now been written for the drug.

Alli is sold in 60 mg capsules - half the dosage of Xenical, at a cost of about $50 for a one month supply of the drug. The over-the-counter approval of Alli was somewhat controversial, with some groups such as Health Research Group arguing that the drug has serious side effects and questionable benefits. Proponents of Alli are pleased that there is now a government-approved alternative to the multitude of herbal formulas and other supplements that promise weight loss but have never been clinically tested. Here at diaTribe, our director of operations, Alisa Bekins, has been on Alli for two months, and she shares her experiences with us below.

rationale

As I stare into the mirror, I wonder what I have been thinking for the past six years. I was 40 pounds lighter then and my back problems were intermittent. Now, my back problems are chronic and all I can do for exercise is walk. This is a wakeup call for me. I am going to go on a serious diet, supplemented by Alli. According to clinical studies, the drug can help people lose twice as much weight as diet alone.

week 1 - mental management

Buying Alli was easy... too easy. Even though the drug is over the counter, patients are supposed to get a briefing from the pharmacist before walking off with the drug. However, at my local Safeway where I bought Alli, the "briefing" was, well, very brief. I was simply handed the medication; I swiped my credit card and left.

Taking Alli requires some getting used to. For one, I have to get used to taking three pills throughout the day and one in the evening. I've programmed my Blackberry to remind me so that I don't forget. I'm also taking a multi-vitamin pill once daily (containing the fat-soluble vitamins A, D, E, K, and beta-carotene) because Alli inhibits the absorption of fat-soluble vitamins and minerals from the digestive tract. The biggest challenge has been changing my diet. In order to reduce the risk of the notorious gastrointestinal side effects, Alli users are advised to severely restrict the consumption of fat. I'm eating only about 1,200 calories a day; I used to eat about 1,900 calories a day. I'm also walking for about an hour a day.

week 3 - going steady

It's only been three weeks, but I can already see results! I've lost about three pounds each week (nine pounds total). I have to admit that it's becoming easier to stay focused. Surprisingly, I have no side effects even though I heard a lot of stories of bad side effects from people on Xenical - I think it's because I'm following directions and I've been eating a super low-fat diet. To be honest, I'm scared about what would happen if I deviate from a low-fat plan, especially if I'm eating out at a restaurant - what could possibly be worse than a bathroom emergency in a restaurant? I'm sticking to salads.

week 8 - results

I'm 22 pounds lighter and down two sizes of jeans since I started! I wonder if I can keep this up. I now weigh myself every Monday morning. Although I'm delighted with my progress, I have to wonder how much of the weight loss is attributable to Alli, and how much of it is caused by my behavior modifications. Alli may be a good weight loss drug, but it is also an excellent motivator for eating well because of the side effects that come with eating large and fatty meals.

When I stop Alli, I really want to avoid regaining all of the weight I've lost. Weight-regain is a very common problem after stopping medication. When I stop Alli, I'm definitely going to stay on this low calorie, low fat diet. I hope that by making my recent behavior changes permanent, I can make my weight loss permanent as well!

In the meantime, our neuroscience expert here at Close Concerns Mark Yarchoan just got back from The Obesity Society conference in New Orleans and is very excited about some combination medicines involving compounds called leptin, pramlintide, and PYY that may prove quite fruitful in human clinical studies, he says.