Many patients and physicians are averse to bariatric surgery for the management of morbid obesity and its attendant evils of diabetes, hypertension, sleep apnea, etc. Fair enough, I say, but then how do you achieve fat loss when you are unlikely to be in the 5% who will achieve it with lifestyle changes? Clearly, people who get morbidly obese are extremely hard pressed to get back into shape and health, even with medical supervision.
In this scenario, they often resort to taking drugs to help with weight loss. One such drug, now popular all over the world, is Orlistat, sold over the counter in the US as Alli.
The drug works by inhibiting the digestion and absorption of ingested fat in the alimentary tract. Net result- the ingested fat is passed off in the stool. So, the patient can eat fats and not put it on– after all, it is not getting absorbed into the body. Cool, ain’t it?
Not really. The drug, as we have seen with rimonabant before, is not without its inherent problems. The stools become oily and loose, not to say foul-smelling. As a result of this, much time is spent in the toilet. If that is not bad enough, the oil trickles in through the anus and soils your clothes!
Orlistat (sold in India in the names of Reeshape or Obelit, among others) also causes malabsorption of fat-soluble vitamins and could be harmful if consumed for longer periods of time. Remember that fat is an important macronutrient for the body, even in fat people!
According to this report (and some others), Orlistat has been found to cause severe liver toxicity, including liver failure in several patients, leading the FDA to launch a product review on the drug.
FDA said it “is not advising healthcare professionals to change their prescribing practices with orlistat. Consumers currently taking Xenical should continue to take it as prescribed, and those using over-the-counter Alli should continue to use the product as directed.”
But the FDA advised orlistat users to “consult their healthcare professional if they are experiencing symptoms possibly associated with the use of orlistat and development of liver injury, particularly weakness or fatigue, fever, jaundice, or brown urine. Other symptoms may include abdominal pain, nausea, vomiting, light-colored stools, itching, or loss of appetite.”
However, if history is any indicator, it is our prediction that this will go the way of rimonabant and Ephedra and die a natural death in some time in the future.
[...] We have said it before that orlistat can cause liver problems, and is a candidate for withdrawal. Now the world is told that sibutramine has been withdrawn in the US, Canada and Europe because of heart attacks (the SCOUT study). [...]