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Anti-obesity drug now available through pharmaciesSeveral newspapers have highlighted the decision to release orlistat, a prescription-only obesity drug, for sale 'over the counter' at pharmacies. The drug will be available for sale to adults with a BMI of 28 or more. GlaxoSmithKline, which manufactures the drug, has said that clinical trials had shown "adding orlistat to a reduced-calorie, lower-fat diet, can help people lose 50% more weight than dieting alone". The over-the-counter Alli pill is a lower-dose version of orlistat, which is only available by prescription. It works by preventing the body absorbing fats from the diet, thereby reducing calorie intake. People taking the drug should avoid fatty foods and stick to a reduced-calorie diet. At the standard prescription dose of 120mg three times per day before meals, orlistat prevents approximately 30% of dietary fat from being absorbed. At the new over-the-counter dose of 60mg, the drug prevents absorption of around 25% of dietary fat. Alli is associated with some unpleasant side effects, most commonly oily, diarrhoea-like stools that may leak. This occurs because orlistat blocks some dietary fat in the digestive system from being absorbed, which exits the body intact in the faeces. Other problems can include wind and frequent or urgent bowel movements and abdominal bloating. The drug will interfere with the absorption of fat soluble nutrients such as vitamins A, D and E, as a result the drug is unsuitable for children and it may result in deficiency related complications even in adults. The drug should be avoided by those who have problems absorbing nutrients, those on anticoagulant medication, those with bile obstruction and pregnant women. The drug is unlikely to have the dramatic results the obese user will be hoping for; as a sole strategy for weight loss taking Alli will fail. In one-year clinical trials, about one-third to one-half of people achieved a 5% or greater decrease in body mass, not all of which was fat mass. After orlistat was stopped, a significant number of subjects gained weight, with some regaining up to 35% of the weight they had lost. Tim Brooks, a spokesman for GSK, is reported in the Times newspaper as saying that: "A change in lifestyle is the key way for anyone to lose weight. This drug is not a magic bullet as there is no single solution to losing weight, but for every 2lbs (0.9kgs) someone can lose through by healthy eating and exercise, Alli could help them lose an extra 1lb on top of that." So, as with all clinically successful weight loss aids, Alli can only work as a "kick start" to improve weight loss rate as diet and lifestyle is adjusted. Conjugated linoleic acid (CLA), a naturally occurring polyunsaturated fatty acid, has been found to significantly reduce body fat mass while increasing lean mass independent of diet and exercise when taken for three to six months. As with Alli, CLA should be used as part of a weight management regime incorporating a balanced diet and physical activity, but it is not associated with side effects when used in combination with an antioxidant supplement. Obesity is a very complex problem, at its heart is the equally complex interactions between genetic make up and the environment and individual and cultural relationships with food. It is vitally important that the obese seek advice from a qualified nutritionist or dietician and a GP to advise them on how to change their lifestyle for long term, safe weight loss and to help them manage the health complications arising from obesity. Eating a balanced low glycaemic, calorie appropriate diet rich in fresh fruit and vegetables, fish, lean meat and wholegrains combined with regular physical activity remains the optimal pathway to health. |