EDITORIAL: Over the Counter Diet Drug A Fat Pill With Worries

By The Philadelphia Inquirer

Jan. 28–If only there were a miracle drug…

A tiny pill that could melt pounds the way other medicines have stabilized blood pressure and lowered cholesterol. That could quickly trim bulging midsections now plaguing two-thirds of American adults and encumbering the health-care system. A pill that could be the breakthrough overweight Americans seek when they try $1 billion worth of wacky weight-loss remedies a year.

It’s not that easy. Weight loss just doesn’t come in a bottle. For most people, it takes sweat and hard work to change the way they eat and exercise. Many Americans aren’t interested in that equation.

So pharmaceuticals keep trying to help them. The latest effort, orlistat, by Glaxo SmithKline Consumer Health, received preliminary approval Monday from the Food and Drug Administration.

Glaxo argues that orlistat, marketed as Alli, will be the first FDA-approved weight-loss agent sold over the counter. “Allied” with a low-fat diet and exercise, orlistat will give motivated dieters the regimen they need to finally shed pounds.

Opponents counter it’ll be expensive (up to $3.60 a day) and provide only modest results (5 percent of body weight over six months) — hardly worth the potentially brutal side effects and possible vitamin deficiencies.

Consumers shouldn’t jump in blindly when orlistat comes to market in about six months. This is one drug for which they’ll need to read the fine print.

Taken before each meal, the pill blocks absorption of fats. The bad news is that fat has to go somewhere. It’s discharged in bowel movements, but not necessarily predictably or comfortably. The drug’s side effects include diarrhea, flatulence and oily anal leakage — all of which can come on without warning. These effects may dissipate over time and can be mitigated by avoiding fatty foods.

“It forces you on a low-fat diet, or you pay the piper,” said Tom Wadden, director of the Weight and Eating Disorders Program at the University of Pennsylvania School of Medicine. He likened it to disulfiram, a drug that makes alcoholics vomit profusely if they drink alcohol.

Call it the “scared straight” approach to weight loss.

Even so, orlistat offers an option for people who have failed repeatedly with diet and exercise alone. Unlike dietary supplements, such as the faddish South African cactus extract Hoodia, at least it’s undergone clinical trials and government review.

Teenage anorexics and bulemics will be unlikely to abuse orlistat, as some fear, because of its slow pace of weight loss and unpredictable side effects. Still, it’s wise to restrict sales to adults over 18, as Glaxo plans.

Obesity doctors hope orlistat will help users adjust to a new diet and exercise regimen within six months, so they no longer need the drug. Glaxo plans to offer educational package inserts and online counseling.

For that to happen, people need to stop chasing diet miracles and behave rationally.

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