A close look at orlistat: Xenical and My Alli

Orlistat is found in prescription Xenical in 120 mg doses and over-the-counter My Alli in 60 mg doses.

Orlistate has been used in a number of fat control and fat loss studies. Trials which used control groups and used patients with uncomplicated obesity (that is patients who did not have obesity due to untreated medical conditions) showed statistically significant differences between the placebo control group and the orlistat group on who achieved more weight loss. Those using orlistat achieved significantly greater results (5% or greater decrease in body mass on average). It not only resulted in more weight loss, it resulted in a decrease in health complications related to being overweight or obese, such as high blood pressure.

These studies also showed the rather well-discussed side effects orlistat is known for, of course. Studies politely refer to these side effects as “a higher incidence of gastrointestinal adverse events” and what My Alli politely calls “treatment effects” but what that translates to in the real world is an increase in flatulence and the amount of grease in bowel movements. With too much of a grease increase, caused by a particularly fatty diet, this may also result in grease-filled flatulence.

That's a pretty gross side effect, but one that can be controlled by not consuming more than 15 grams of fat per meal. You'll still have greasy stools, but should, in theory, not have any trouble with unexpected grease sharts. My Alli treats this as a form of aversion therapy – one time sharting your pants full of orange grease and you'll avoid fatty meals forever.

In addition, fat-soluble vitamins, like vitamin K will not be absorbed very well when on a medication containing orlistat. A multivitamin taken either at night or with a meal you do not take orlistat with will help counter this.

And finally, from all the trials the thing of most interest is what happened after they went off orlistat. After 1 year, those in the diet-only group of twostudies regained 55% - 63% of the weight they had previously lost back, while those in the Xenical group only regained 32% - 35% of the weight they had previously lost back.

After looking at the studies, it looks like orlistat deserves its FDA approval and place as a medication that helps people lose weight. I have high hopes I'll see some effects (hopefully weight loss and not panties full of grease) from using this for the next 30 days. First I'll be using Xenical for 30 days and then I'll be using My Alli for 30 days.