So let’s talk about Orlistat, which is the name of the drug, otherwise called Xenical or Alli which is the brand name

This drug is one of the longest studied and safest. It is the only one approved for use in adolescents.  It has been shown to have a good heart safety profile and beneficial effects on cholesterol levels.  There are rare cases of a severe liver disease.

The way it works is by inhibiting the enzymes made by your pancreases that break down fats, called lipases.  When food goes into your stomach and the top part of your small intestine it passes the pancreas.  Normally the pancreas releases enzymes that digest fats, proteins and carbohydrates.  Orlistat stops the pancreas fat enzymes, so you don’t break it down and hence do not absorb that fat.  Then the fat just continues to travel down through your gut and you poo it out.

The problem with this however is we need some fat as there are certain vitamins that are associated with them, in particular, vitamins ADEK, hence sometimes people are told to take a multivitamin at the same time.  

The other issue issues it has a few side effects related to that fat in the gut – intestinal gut noises, cramps, farting, losing control of your stools called faecal incontinence, oily spotting discharge from the anus

The recommended dose is 120 mg three times a day, so that is a pill 3 times a day which can be a barrier for some people

When we look at its effectiveness we see trials with 12-month outcomes, patients randomly assigned to orlistat plus a behavioural intervention lost 5 to 10 kg or 10-20 lbs (8% of baseline weight) compared with 3 to 6 kg in the control group (placebo plus behavioural intervention), for a mean difference of 3 kg or 6 lbs.  Meaning you will lose an extra 3kg or 6lbs on the drug after 12 months

The cost is about $90 AUD a month in Australia or $55 USD a month in the USA