Dr. Peter Vash and Alli Complications

On February 11, 2007, the United States Food and Drug Administration (FDA)approved the diet drug Alli, also known as Orlistat, and previously available as the prescription drug Xenical, for over-the-counter sales.

Dr. Peter Vash

The drug works by blocking absorption of some of the fat consumed in the diet. Xenical has been available in the United States since 1999, and Alli is the same drug, only at half the dosage of the prescription-strength product.

Xenical will still be available as a prescription to help obese people lose weight with the guidance of their doctors. GlaxoSmithKline, makers of [alli], say taking the drug as directed can help people lose 50 percent more weight than with diet and exercise alone.

For instance, if you were able to lose 10 pounds on your own, taking Alli while eating a low fat diet could help you lose 15 pounds. It sounds like a drug that will be a great help for a lot of people, but many doctors worry that making a diet drug available over the counter will cause problems for people who don't follow the directions or aren't aware of potential side effects.

Dr. Peter Vash, executive director of Lindora Medical Clinics, is one of those doctors. Lindora is the nation's largest medically supervised weight loss and weight control program, and Vash is a board-certified internist specializing in endocrinology and metabolism, with an emphasis on obesity and eating disorders.

Dr. Vash took a few minutes out of his busy schedule to give us his thoughts on Alli, its potential problems, and how it can be used successfully.

Potential Problems and Side Effects

LovetoKnow: What worries you the most about the FDA's decision to allow Alli to be sold over-the-counter?

Peter Vash: Patients will not follow the directions on the packaging and thus experience potential side effects.

LTK: What are some of the side effects people should be aware of before they start taking it?

PV: Flatulence, loose oily stools and cramping (especially in the lower abdomen). It is important to remember, though, that these side effects are much more likely to occur when the medication is not taken as directed.

LTK: What are the dangers of having this kind of drug available over-the-counter?

PV: The danger is that individuals will not follow the guidelines and may abuse the medication and suffer side effects.

Getting Help from a Doctor

LTK: How can working with a doctor help people lose weight as opposed to going it on their own (with or without drugs like alli)?

PV: Doctors specializing in bariatrics (weight control) are able to provide patients with a diet that works for them and that may incorporate such medications as alli with minimal side effects.

LTK: What do you think is the right way to use medicines like Alli as part of a weight loss plan?

PV: Alli can be useful depending on the patient’s unique set of circumstances. Those who qualify may find a slow progressive weight loss over time.

The Final Word

Vash emphasized that Alli can be taken safely if used as directed and that working with a doctor would result in the most positive results.

"Long term results are best achieved through a qualified doctor/patient interaction," he said. It is also important for people thinking about using Alli to know that it is not a panacea that will allow people to eat whatever they want.

Instead, patients who want to use Alli should be prepared to make diet and lifestyle changes that the drug can compliment by helping people lose a little more weight.

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