Health Options Alan Titchenal  & Joannie Dobbs                    Sunday , February 12, 2006

Fat-blocking drug comes with various drawbacks

EATING TOO MUCH FAT not only makes it difficult to maintain a healthy level of body fat, but also is associated with an increased risk of heart disease, diabetes and cancer. Consequently, it made sense for the Food and Drug Administration to approve an over-the-counter form of the prescription fat-blocker Xenical, also known as Orlistat. If this drug receives full FDA approval, it could be in the marketplace by summer.
For overweight and obese people who consume high-fat diets, Alli (the non-prescription name for Xenical) seems like the perfect answer. But is it?

If Xenical effectively treated obesity, a growth in sales would be expected over the years since its introduction in 1999. But according to Dr. Sidney Wolfe of the Public Citizen Health Research Group, sales have declined significantly.

Question: Does Xenical work?

Answer: When taken with a meal, Xenical blocks the action of enzymes that digest fat so that about one-third of the fat in a meal passes through the intestines unabsorbed.

Q: What happens to the unabsorbed fat?

A: When Xenical is taken with a high-fat meal, unabsorbed fat enters the lower intestine, where it can cause gas, lower-intestinal discomfort and oily stools. The lower intestine is not accustomed to controlling the movement of oil or grease. Other side effects can include increased frequency and urgency of bowel movements. Also, undigested oil or fat can leak out and cause oily spotting on clothing. To avoid these side effects, the user must consume a lower-fat diet.

Q: Are there other concerns?

A: Along with decreased fat absorption, the absorption of fat-soluble vitamins and many beneficial phytochemicals is reduced. Taking a daily multi-vitamin supplement and eating plenty of fruits and vegetables is important.

A non-prescription version of this drug has a high potential for abuse by those with eating disorders and by teenagers attempting to stay lean.

Also, the drug could cause learned aversions to healthful foods. If you feel ill after consuming a food, it is natural to avoid that food in the future (possibly for a lifetime), whether it caused the problem or not.

The bottom line: This fat-blocker must be used with a lower-fat diet and low-fat diets already help promote weight loss. So, is the drug really needed?