Today, instead of replying to one of the hundreds of fat loss questions I receive every week, I felt not only compelled, but obligated to comment (rant) on what I REALLY think about the “fat blocker” drug Xenical (Orlistat) going over the counter (OTC) in a reduced strength version called “Alli” …and to comment on what I REALLY think about diet drugs in general…

According to news headlines today, Xenical (Orlistat), will become the first over the counter diet pill in the United States.

alli.jpgXenical has previously only been a prescription drug approved by the FDA for weight loss. The drug works by blunting fat absorption by blocking the digestive enzyme lipase.

The prescription version of the fat-blocking pill Xenical made by Roche was originally approved in 1999. Two years ago, GlaxoSmithKline bought the United States rights to Xenical from Roche

On January 24th, 2006, Federal health advisors voted 11-3 to recommend approval of over-the-counter sales of a (lower dose) version of Xenical, after an all day hearing.

Now, after the long FDA review process, the first ever FDA approved over the counter weight loss drug has been cleared for sale under the name Alli.

What is Alli (Orlistat) and what does it do?

Typically, weight loss drugs are designed to curb your appetite. Alli does something totally different: It prevents some of the fat you eat from being absorbed – it simply passes through your digestive system.

In case you’re wondering, yes, there are potentially uncomfortable and even embarrassing gastro-intestinal side effects: oily discharge, leaking, urgency, flatulence, oily spotting, liquid stools, incontinence…

Oh, forget the political correctness… it can make you sh** your pants! (still enthused about this “wonder pill?”)

An appetite suppressant or a thermogenic is not a long term solution to obesity either, but at least they might have some type of value under certain circumstances when there are no contraindications and the cost to risk benefit is acceptable.

Xenical on the other hand? This drug is just plain dumb and so is the idea of making it OTC.

The truth is, if you are really thinking long term, and particularly if you are not morbidly obese, ill, and in need of any and every means of last resort, then…


Certain drugs may have benefits, maybe potentially life-saving benefits in some cases, but they do not “cure” diseases. Drugs do not heal. Drugs hide. Just because you sweep the dirt underneath your carpet doesn’t mean your home isn’t still filthy.

A drug can only temporarily relieve symptoms. Key word: temporarily.

Did you ever consider for a moment that body fat is a symptom?

A symptom of inactivity.
A symptom of suboptimal nutrition.
A symptom of accumulated poor lifestyle choices.
A symptom of negative thoughts and beliefs that manifest into unhealthy behaviors.

Taking drugs is like clipping the leaves off weeds to try to keep weeds out of your garden, but the only way to keep the weeds out of your garden is to PULL THEM OUT BY THE ROOTS!

Plus, every drug – including over the counter drugs – has side effects – sometimes extremely serious side effects. That doesn’t mean no one should ever take any drugs. It means you must consider the risk to benefit ratio of any drugs you take before making a decision and you must at the same time find and deal with the true cause of the problem instead of treating the symptom.

When you combine a supportive healthy nutrition program that FEEDS and maintains muscle, consisting of natural, unprocessed foods, with a lifelong exercise program that BURNS FAT, then you have yourself a long term health solution. This is the only true way to rip the weeds of obesity out by the roots.

Making this drug over the counter is a big mistake. Why?

Well, first of all, by going OTC, it may encourage people to start becoming fat phobic again.

Didn’t we go through an entire decade of low fat diets already… and then go through another decade of low carb diets?

Are we now going to go through another fat phobia phase? A balance between macronutrients is ideal, not removal of an entire food group, whether that is fat or carbs or whatever. Whatever happened to BALANCE!

Dietary fat doesn’t make you fat, and most people are woefully lacking in good, healthy essential fats like those found in fish, fish oil, nuts, flax and so on. Using fat blockers will probably mean less absorption of the good fatty acids so necessary for good health.

Second, this drug also has great potential for un-policed misuse and abuse if it goes over the counter.

One year ago, when this OTC proposal was first announced in the news media, Jim Foster of the excellent website wrote, “This will not help those who already have problems with laxative abuse. A number of groups are concerned it will be used as medicated bulimia – encouraging binge-eating in young people.”

In his blog article, ‘Xenical Over the Counter: Big Mistake?’ Foster continues..

“On the MSNBC site, there is an overwhelming vote of confidence for the drug. Of over 132,000 votes 59% say they will try it because “…I can’t lose those last 10 pounds.” Of course, these results are very skewed as the people reading the article are people with an interest in the drug. Even so, these results are concerning. I strongly believe that a drug such as this must be prescribed by a physician. This move will simply enforce the quick-fix mentality. Xenical is already guilty of a series of aggravating ads in Canada – attempting to associate glamour with the drug.”

Third, Xenical, and now Alli, may encourage people to eat more fatty, sugary refined junk food instead of less because they may be thinking that part of it won’t even be absorbed.

Fourth, another problem is that fat soluble vitamin intake will go right out the you know what, along with the fat. Doctors usually recommend a multi vitamin supplement to patients taking Xenical for this reason.

You know what I think? I think this is a desperate attempt to revive a lousy loser drug that many people have taken a pass on refills due to its undesirable side effects and long term ineffectiveness.

If a doctor told you that you had diabetes or high blood pressure or high cholesterol… or even that you were suffering from depression, what would your response be?

Im not sure about you, but most people, especially Americans, would instantly say, ‘OK what drug should I take?” and the physician would be quick to prescribe it.

Many physicians and health professionals consider obesity to be biggest disease in the world, and they say that it should be treated like one.

The truth is that obesity is one of the biggest businesses in the world and is being treated like one!

Weight loss is potentially the biggest market on Earth for drug sales, and the stakes couldn’t be higher.

The Glaxo company estimated that 5 to 6 million Americans a year would buy the drug if offered over the counter. Those numbers could mean at least $1.5 billion a year in retail sales.

Glaxo also says that Alli would cost $12 to $25 a week. Sounds like a hundred bucks a month down the toilet (literally!) if you ask me.

But what about the research? Clinical trials showed that patients taking xenical lost on average 5.3 to 6.2 pounds more than weight than the group taking a placebo.

In 6 month clinical trials for the proposed over the counter drug, patients on Alli lost 4 to 5 pounds more than the group taking a placebo

What do I think abo
ut that?

Maybe the subjects ate less fat due to the fear that eating fat = leaking stools. On one website, a patient answering a survey said, ‘The drug forced me to avoid fatty foods if I wanted to keep my underwear clean. I lost a lot of weight.’ (Nice)

Maybe some of the subjects in the studies felt that it wasn’t working so they dropped out. Diet drug studies have very high drop out rates, so the people remaining were the ones who got the best results.

Maybe if the control group and the placebo group were put on the same caloric intake, then the group taking xenical lost more weight simply because fewer dietary fat calories were absorbed!

Do you think if you weren’t in a controlled study environment where your food intake was monitored, you would really control your intake, or would you be more likely to eat a bunch of greasy junk because you were thinking your body wouldn’t absorb it?

Translation: the study results are biased, skewed and misleading


My advice to all our fine medical doctors out there: start prescribing weight training, cardio and sensible eating first, and drugs only as means of last resort. Stop fattening the wallets of the drug companies.

My advice to the legislators and government agencies involved: You are making a big mistake making this drug over the counter. Keep it by prescription only, so at least the doctors can supervise and “police” it’s use and it doesn’t get abused by teenagers and people with just 10-30 pounds to lose who really don’t need it.

My advice to everyone who wants to get healthier and leaner:

“Burn The Fat and Feed The Muscle”. Make that Your MANTRA!

You gotta exercise (BURN) and you gotta eat (FEED). If you do these two things right then even if the pharmaceutical giants come out with a pill that really is safe and actually works, you can save your money because YOU won’t need it!

Train hard, eat right and expect success,

Tom Venuto, NSCA-CPT, CSCS


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