Orlistat: A miracle slimming pill?

Orlistat (also known as Xenical), the controversial slimming drug recently given the green light for NHS funding, FAILS to prevent weight regain following a low calorie diet.

A recent study found that orlistat users regained almost seven pounds (three kilograms) of the bodyweight they had previously lost, despite continued use of the drug.

"One must question why after one year of treatment three fourths of patients had begun the relentless process of weight regain despite continued orlistat therapy," says Charles H. Halstead, editor-in-chief of the prestigious American Journal of Clinical Nutrition.

Although orlistat has been touted as an "easy slimming aid," yearly treatment leads to just seven pounds (three kilograms) of extra weight loss. That's less than 0.2 pounds (0.1 kilogram) per week.

At an estimated annual cost to the NHS of £12 million, this makes orlistat a rather costly solution to the rising tide of obesity in the UK. Especially when you consider that the same weight loss could be achieved by cutting out 81 calories per day — the equivalent to just ¼ of a Snickers bar or 25 minutes of moderate physical activity

Orlistat works by reducing the absorption of dietary fat. However, there is concern that users may simply "out-eat" the drug — eating more because they know they can get away with it.

Side effects

Orlistat also comes with some unpleasant side effects, with users complaining of several "hurried" visits to the toilet. Moreover, studies show that orlistat treatment reduces the absorption of vitamins D and E, creating a need for vitamin supplementation.

The medical profession often criticizes popular diets on the basis that they only work as long they're followed. Once the diet is over, the individual regains the weight they lost.

Surely, the same must hold true for orlistat?

As soon as an individual stops treatment, the lost weight soon returns. For orlistat to be truly effective, it would need to be taken for a lifetime, providing Hoffman-La Roche, the drugs manufacturers, with a lucrative stream of income from users desperate to avoid piling on the pounds.

It's also worth pointing out that several "independent" trials investigating the effects of orlistat have involved Jonathan Hauptman, either as lead researcher or co-author. Not surprisingly, Hoffman-La Roche also include Hauptman on their list of employees.

Orlistat does not allow fat people to eat what they like and get away with it. However, the unpleasant side effects of orlistat and a high fat diet mean that users have a powerful incentive to reduce their intake of fat.

"It will be ironic if this new drug succeeds by exactly the action which it was said not to have," says John Garrow, a former Professor of human nutrition, "by inducing obese people to keep to a low fat diet".

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References
1. Davidson, M.H., Hauptman, J., DiGirolamo, M., Foreyt, J.P., Halsted, C.H., Heber, D., Heimburger, D.C., Lucas, C.P., Robbins, D.C., Chung, J., & Heymsfield, S.B. (1999). Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. Journal of the American Medical Association, 281, 235-242
2. Hill, J.O., Hauptman, J., Anderson, J.W., Fujioka, K., O'Neil, P.M., Smith, D.K., Zavoral, J.H., & Aronne, L.J. (1999). Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: a 1-y study. American Journal of Clinical Nutrition, 69, 1108-1116