Weight loss pill comes at a price
By Aaron Wasserman
Cautiously complimented by dieticians and an easy punch line because of its unseemly possible side effects, the new weight-loss pill alli is a unique entry in its industry.
Alli, an over-the-counter pill, has an uncommon marketing approach: It acknowledges that it is not a panacea; weight loss happens slowly; and is only effective if people change their eating and exercise habits at the same time.
Those admissions, dieticians interviewed this week said, are encouraging. But they added that since alli does not need a physician's oversight, it could be misused.
"The marketing campaign is definitely different because of the educational component they put in by giving some basic, good nutrition advice," said Denise Foresman, a clinical dietician at Heywood Hospital. "They are not advertising as a miracle diet pill for losing an enormous amount of weight. They are definitely saying it is an aid in a weight-loss program."
Alli, pronounced like the noun "ally," is also the only available weight-loss pill approved by the federal Food and Drug Administration. The approval came in February.
"It's controlled, we know what it does," said Gisele LeBlanc, clinical nutrition manager of HealthAlliance Hospital, explaining the approval's benefits. "A lot of the other drugs that are alternatives are packaged herbals, and because they're not controlled by the FDA, what's on the bottle is not what's in the pill and the effects have not been thoroughly tested."
Alli works by inhibiting lipase enzymes, blocking fat absorption. Fats instead pass through the digestive system undigested, reducing caloric intake. The pill is a weaker version of Xenical, a prescription weight-loss pill available for the past several years.
Alli's manufacturer, the pharmaceutical company GlaxoSmithKline, recommends taking one pill per meal, touting a 50 percent increase in weight loss compared to that for regular dieting. Ninety pills cost $60.
Alli debuted slightly more than two weeks ago with an approximately $150 million marketing budget from GlaxoSmithKline. It is now prominently displayed in nearly all pharmacies and discount retailers. Wal-Mart has even installed a phone at its display with pre-recorded messages about alli.
In its first few weeks, alli has also gained some notoriety for its side effects.
Because the product's design sends fats through the digestive system undigested, it can dramatically impact someone's bowel system. GlaxoSmithKline warns of increased flatulence, oily discharges and loose and more frequent stools that can verge on incontinence if too much fat is eaten. It recommends new users wear black pants and carry a change of clothes until they adjust to their new diet.
The Prescription Access Litigation Project of Boston is one of several to take advantage. In a press release criticizing alli's over-the-counter availability, it gave the pill the "With Allies Like This, Who Needs Enemas?" award.
But the brochures that accompany alli warn the pill "is not a quick fix" and "works only if you work, that means committing to a reduced-calorie, low-fat diet."
"We know fast weight loss didn't work," said Dr. Caroline Apovian, director of the Center for Nutrition and Weight Management at Boston Medical Center and a GlaxoSmithKline consultant during the FDA approval process. "Everyone gained the weight back. Even though this is the difficult message for people to hear, it's the right message."
Apovian is also the author of an accompanying book with advice on exercise, recipes, grocery shopping and dining out. The marketing also urges buyers to "learn about food, nutrition and healthy eating habits" and keep online journals.
"The food journaling is a wonderful idea, as well as the exercise, because we need to get back to the basics of why we want to eat and our relationship with food," Foresman said. "It's all behavioral. I see some of that as being the positive -- this pharmaceutical company is actually heading that way."
But Foresman also said she has several concerns because alli is available over the counter. Without a physician's involvement, she said, it is hard to monitor's someone condition while taking alli or address other health problems tied to obesity, such as heart disease and diabetes.
"In the medical field, we know a lot of human beings will say if one tab is good, then two tabs will be better," Foresman said, explaining that might prompt consumers to take extra pills without committing to the comprehensive weight-loss regimen.
LeBlanc also said alli could negatively affect people's intake of the fat-soluble Vitamins A, D and K. Because alli blocks lipids from absorbing fats, it does the same for those vitamins.
Apovian said alli will not harm those prone to taking too many pills because it does not enter the bloodstream as some weight-loss pills do.
She acknowledged there is no way to force alli users to change their lifestyles, but said that those who do not adopt new exercise and eating habits will not see notable weight changes.
"I think the makers of the product have said all along this is not for everyone. We want you to take it if you're ready to change your lifestyle," Apovian said. "The person who this will help is someone who already wants to change."
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