Weight-loss pill is no wonder drug, some say
BY TAMMIE SMITH
Lynn Moreau works out faithfully at Curves in Libbie Place in Henrico County and is a few workouts away from earning a T-shirt for her 300th workout.
But taking a diet pill to lose weight or maintain weight loss is something Moreau said she would never do.
"The risks outweigh the benefits," Moreau, who gave her age as "pushing 50," said as she worked out Friday. "There's no magic bullet to getting healthy. That's not what people want to hear," said Moreau, a registered nurse who takes care of women with high-risk pregnancies.
The Food and Drug Administration's decision last week to allow over-the-counter sales of the weight-loss drug orlistat is being met with both optimism and skepticism. The drug will be sold under the name "alli" in 60-milligram capsules, about half the strength of Xenical, the prescription version of the drug that has been sold in the United States since 1999. Alli may be in drugstores by summer.
The optimism is because there is an over-the-counter, FDA-approved drug that might offer help to Americans who are overweight. National estimates suggest two-thirds of U.S. adults are overweight and almost a third are obese, and that the percentage of children who are overweight or obese is rising rapidly.
Such estimates have prompted a flurry of public-health efforts to address what some call an obesity epidemic. Virginia legislators, for instance, have for the past few years introduced bills to require schools to do more to get children physically active and to make school meals healthier. One of the four committees of Gov. Timothy M. Kaine's health-reform commission is looking at ways to help Virginians live healthier lifestyles.
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As an anti-fat pill, the prescription version of orlistat has gotten mixed reviews. Even those who say it can be helpful caution about the side effects.
"I've had a pretty successful experience with it," said Elisabeth A. Peterson, a registered dietitian in private practice in the Richmond area. "It's definitely not a quick fix." Users must balance taking alli with nutrition and exercise, because the pill does not work well on its own, she said.
The drug works by blocking absorption of fat in food. Fat, with about nine calories per gram, has more than double the four calories per gram of carbohydrates and proteins.
People who use the drug are advised to limit their diet to no more than 30 percent fat. Those who don't could find themselves suffering one of the drug's well-known side effects -- loose, oily stools.
Dr. Daphne Bryan, a family physician at VCU Medical Center, has had patients try Xenical.
"Quite a few didn't tolerate the side effects or did not want to tolerate the side effects," Bryan said. "The impact is pretty immediate once you eat fat and you have taken orlistat -- flatulence and oily substances. Sometimes you can have leakage on clothing. If that happens once, that is all it will take for patients to come off."
Anti-diarrheals won't prevent the bowel issue because that's how the drug works, said Brenda Davy, a Virginia Tech weight-management and nutrition expert who was involved as a researcher in the clinical trials of Xenical.
The drug will help users achieve a moderate weight loss of a couple of pounds over several months, said Davy, who agreed that it's not a drug that will help users quickly get into a prom gown, wedding dress or bathing suit.
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Experts say consumers should use orlistat in conjunction with changes in nutrition and regular physical activity. And although the weight loss may not be dramatic, it can help reduce the risk of conditions associated with obesity, such as heart disease.
Results of drug trials show that after taking the drug for a year, 57 percent of patients treated with orlistat lost at least 5 percent of their baseline body weight, while 31 percent of those taking a dummy pill lost that much. Those results are based on five studies that collectively enrolled about 1,500 people.
Public Citizen, a consumer advocacy group, has different concerns. In April 2006 it petitioned the FDA to remove orlistat from the market. The group says research in rats suggests the drug might be linked to lesions that are a precursor to colon cancer. The FDA denied the petition.
Dr. Neil Hutcher, medical director for the weight-loss surgery program at St. Mary's Hospital, said orlistat is not likely to reduce the demand for procedures such as gastric bypass surgery, which removes most of the stomach so people eat less.
"If you are 300 pounds, have diabetes and you want to lose enough weight to impact your diabetes, this is not going to be a whole lot of help," said Hutcher, of Commonwealth Surgeons.
Hutcher said there is bigger buzz over rimonabant, a drug in the FDA-approval pipeline. The drug acts on brain chemicals associated with making people hungry after they smoke marijuana.
"Through research on why pot made people hungry, they found this whole new class of receptor sites in the brain," Hutcher said. "If these receptors can make you hungry, maybe blocking these can produce an absence of hunger."
Contact staff writer Tammie Smith at TLsmith@timesdispatch.com or (804) 649-6572.
Times-Dispatch staff writer A.J. Hostetler contributed to this report.
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