June 19, 2007

Alli: Lots of Questions

A new diet drug is on the market, and people seem to have strong feelings about it. Crabby, who is ordinarily opinionated about everything, feels a bit left out. She's all rarin' to climb up on her soap box and spout off--but she's not quite sure what to spout. She's hoping you folks will help her figure out what to think about Alli, so she can locate her self-righteousness again and pretend to be a Crab Who Knows Everything.

Some background:

Alli is a weaker, non-prescription version of the drug Orlistat. It works by interfering with fat absorption, blocking about 25% of the fat you eat.

Users are supposed to diet in conjunction with using the drug, and the manufacturers say it will typically result in a 50% greater weight loss than one would get from dieting alone.

However, Alli can cause disconcerting side effects if you eat too much fat while taking it: "loose or more frequent stools that may be hard to control, or gas with an oily discharge."


An LA Times article says Alli is flying off the shelves in Los Angeles. By contrast, no winged diet pills were observed further north in the Oakland/Berkeley area, where Crabby stopped by her local pharmacy. The guy behind the counter didn't even know what Alli was. But one would assume that if it's an over-the-counter diet drug with a large marketing campaign behind it, people will be sooner or later be buying it with enthusiasm. Especially if it works.

So here's what Crabby doesn't like, so far, about Alli:

Crabby wonders if it's a such a good idea to take something for the long term that interferes with the way your body naturally works. She also wonders if Alli allows you to get and process enough "good" fats--she's hoping someone smarter than she is has some more information about this. The limit per meal for any kind of fat is about 15 grams.

And the L.A. Times article featured a bunch of superficial-sounding women who were completely ignorant about how it worked and who were going to use it anyway. (Crabby hopes they'll be stocking up on Depends along with their pills). Are they typical? Who knows. But they're certainly out there.

There's also an interesting recent study that concluded: "consumers who contemplate taking a prescription or over-the-counter drug" for obesity "become more likely to engage in bad habits like junk food and a sedentary lifestyle."

And finally, there was something kind of yucky about the way the Alli pamphlet tried to soft-pedal the downsides of their medicine. They don't like the term "side effects;" they prefer you call them "treatment effects." And the disgusting oil that you're excreting instead of digesting? Don't be alarmed. "It's not harmful. In fact you may recognize it as something that looks like the oil on top of pizza"!

Yeah, but the "oil on top of pizza" isn't usually coming straight out of your ass.


On the other hand, there are some things to admire about the whole Alli concept and advertising campaign.

For one, their marketing approach is way different than most diet products. Their pamphlet starts right off with: "Your commitment, your hard work, powered by Alli."

Not many weight loss products mention "hard work." Most imply magic.

They offer online help in diet planning. They even have an "are you ready quiz," which asks users to swear, solemnly, like earnest jurors under oath, that they are:

"Willing to do the hard work to lose weight gradually,"
"Committed to following a reduced-calorie, low-fat diet," and
"Committed to making the time to be more physically active."

(They also have to swear they understand about the totally disgusting side effects they'll be dealing with if they eat too much fat).

So Crabby sees both pros and cons. She knows some people are desperate for a little help. Is this something that might be useful?

She's hoping her Smart Readers have some thoughts to share.


  1. Hi Crabby,

    Ah! Another miracle drug!!

    Having been overweight my entire life, I learned that there is no fast cure and that meds like this may (not will) help reduce body weight but can cause other problems. You mention the "oily discharge" problem and the absorption of good fats problem.

    If this pill is emptying out your system so quickly, wouldn't it interfere with the intestinal absorption of all nutrients and particularly of those nutrients like vitamin E that require some fat to aid in absorption?

    I'll pass. (Pun intended)


  2. The "looks like pizza grease" thing is just a slightly less gross way of saying "it's orange". ORANGE. And apparently it stains really bad and has an awful smell.

    No thanks. Eww.

  3. I think I prefer my pizza grease to remain on my pizza. Not on my pants. Too much to ask? And how did they come up with this comparison? they figured pizza grease would make it sound more appealing to their target audience? this kind of reminds me of the whole Olestra thing... it was in those low fat chips and such... not sure if it still is, in the U.S. (I'm in Canada), but who wants to each chips that badly that would result in possible "anal leakage"?? I'd rather eat fewer of the full fat kind, less often, than deal with that kind of side effect or "treatment effect" as they call it with this product.


  4. As you know, having contemplated using this myself, I found that it does indeed interfere with the absorbtion of good fats as well as vitamins. They recommend taking a mutli vitamin before bed. Apparently the side effects are only bad if you are bad (i.e. eat high fat foods) except at the beginning as your body adjusts.

    I don't see it as a miracle pill, nor do they advertise it that way. I see it as a little boost to your weight loss efforts. For this, I see no problem with it.

    I decided not to use it because it simply cost too much.

  5. It never ceases to amaze me what people are willing to put up with to me some arbitrary -- and absurd--standard of what looks good.
    Alli's marketing is brilliant. Instead of suggesting magic it implies that using their product underscores your hard-working committed-to-good-health nature.
    Gotta love "treatment effects."
    As if you're taking solid pro-active steps by using this product. Again, brilliant.
    I've never taken a diet drug so can't offer an opinion based on anything.

    Lauren, I had the same thought about Olestra. And I agree with you about eat the good stuff, but less of it.

  6. Hi Terrie!
    I love that "I'll pass." And good point about vitamin E and fat absorption.

    Chicken Girl,
    Eww, it's orange? Somehow that's even worse.

    Hi Lauren!
    Yeah, you kinda wonder about the market research studies they had to do to come up with "pizza oil" as their term for it. Wonder what the other choices were?

    You know, I think I've inadvertently eaten olestra, because sometimes, in a weak moment, I'll have a few of the junky lowest-fat Pringle's chips. (Taste like salty styrofoam, yet I still like 'em anyway). Haven't noticed any side effects though. Would definitely not be worth it.

  7. Hi half man!
    Thanks for the info. Actually, you've answered two of my biggest questions: do you get the side effects if follow the rules (so yes, at the beginning) and does it mess with nutrient absorption (yes--but still not clear if this is something you can compensate for sufficiently. I somehow doubt it). Thanks!

    Hi leah,
    Now you're smarter than I am, because you were better able to see the sneaky aspect of the ad campaign I was admiring!

  8. This tagline kills me: "Committed to following a reduced-calorie, low-fat diet". Hello. If you are currently on a reduced calorie, low fat diet, you would not need Alli! Also you don't want to block the absorption of polyunsaturated, and monounsaturated fats. The omega fatty acids could also be blocked.

    There is also the risk of dependence. At some point Alli users will get tired of taking it. When someone stops taking this latest wallet-sapper, the weight WILL come back.

    How much does this thing cost. $50/month or something like that? Instead of buying Alli, how about investing that fifty on fruits, veggies, and lean protein?

    Who wants to bet that in 6 months Alli will be pulled?

  9. Maybe one good public shart without a change of clothes is enough for some people to change how they consume fatty foods. I won't be trying it, that's for sure.

  10. So let's see. . . it works best if you change your diet, and probably if you exercise, too. And if I remember correctly, isn't the average weight loss just a few measly pounds, anyway?

    You can get that by changing your habits and NOT taking a pill with "treatment effects."

    People just want the easy way out. Take a magic pill and you won't have to do any hard work.

    I suppose it's possible, though, that the prospect of "treatment effects" could force one to stay on a healthy diet. Negative reinforcement and all that, kind of like Anabuse. If that's the purpose behind the drug, it might work.

  11. check out the unofficial "alli blog" ...

    Seems that alli side effects can be a little smelli ...


  12. The sad thing is so many desperate people will take this pill without fully considering the side effects or the restrictions and end up with horribly embarrassing 'accidents'.

    I can see it now - 'Woman sues drug pill Alli for emotional trauma after public pant-staining humiliation.'

  13. Never heard of it but you've certainly put me off pizza for the day! Maybe you could market that as an effective weight loss programme!

  14. I still say that the answer lies in treadmill powered television sets. No walking, no shows. It would ELIMINATE obesity in what, a couple of years?!

  15. I really don't see the point of this drug. If people were able to stick with a reduced calorie, low fat diet then they wouldn't struggle very much with being overweight. The side effects are way too gross for me to ever consider taking it. I can deal with a headache, stomach pain, dry mouth, etc, but I can't deal with anal discharge.

    I do appreciate how their marketing campaign makes Alli only a small part of losing weight. They clearly outline what you will have to do for it to work, and what's going to happen if you deviate.

  16. Julia: I would buy one of those!

  17. It's gross, no matter how well you eat!

  18. ...and tragically, folks, the pharmaceutical company that produced this wonderpill is going to make tons of cash from it...but hey, at least Kellogg's is making our cereals healthier :-)


  19. Hi Goinggone!
    You're right, I don't think these things are cheap, although I think the prescription version was even more expensive.

    Hi Inbetween!
    Oh god, that made me laugh. I hadn't even heard the term "shart" until recently and I can't say I'm all that pleased to have expanded my vocabulary.

    Yeah there is that possible upside--it could be sort of carrot and stick thing. Eat right and lose weight--or eat wrong and soil you pants in public.

    Thanks Truthman! Didn't even know there was such a thing. I hope anyone thinking of taking it goes there to check it out.

    Hi C!
    (Hmm, I suddenly feel like drinking a fruit punch...) I bet you're right on the lawsuit thing. The fact that there are huge warnings about it certainly won't deter some lawyer somewhere from bringing it to court.

    Off for a bit, back soon...

  20. A reduced fat dietitself interferes with the absorbtion of many vital nutrients.

    Calcium is one that most women should be aware of!!

    With a limit of 15g fat per meal, that's almost what I get just from my fish and krill oils!! Vitamin E, vitamin D, vitamin A and vitamin K are all fat soluble, meaning that you need fat to absorb and use them. Vitamin D and K deficiency is now being implicated in coronary disease and other chronic diseases.

    As for the side effects? I believe it was David Letterman who said it best. "I have just 2 words to say....anal leakage!! Anal leakage, people, anal leakage!" (paraphrased, this was about the prescription strength, which all you need to do is up the recommended dosage to get it)

  21. Somewhere I read that Alli doesn't do much for weight loss because eating fat isn't really the major cause of fatness, but eating carbs is. Alli doesn't do anything about your sugar and bread and pasta intake.

    Even if it really was a magic bullet, I'd think twice about a pill that carries the warning: "It's probably a smart idea to wear dark pants, and bring a change of clothes with you to work". Ew.

  22. I have a couple of thoughts.
    1. What will all that "pizza oil" do to our sewer systems? Can I get Roto-Rooter on the NYSE?
    2. Yuck. EEEwww, yuck, eeewwww.

  23. Again, you guys totally make me laugh.

    Did Anonymous perhaps sum it up for us? "Yuck. EEEwww, yuck, eeewwww."

    No one here seems to be a big believer in Alli? Gosh, you guys are a tough crowd. What's a little anal leakage between friends?

    Poor Dawn, sorry I put you off your pizza!

    Julia, I'm with Chicken Girl--treadmill powered tv's are a great idea! Or maybe even treadmill powered refrigerators: No walking, no dinner!

    Hi Noah-- No anal discharge for you either, huh? Can't imagine why you'd pass that up. And thanks for coming by again!

    Hi cactusfreek-sorry i was a little too slow posting this. You had a great comment in the previous post on this very subject. I should have read that first--it answered some of my questions!

    Hi Dietking!
    You had a great post on this too, and raised some really good questions about how you keep from getting dependent on it. Thanks!

    Cindy--that's some really good info on fat soluble vitamins. I had no idea so many important ones were. It just seems like there's more and more research saying we need some fat, especially "good fats" in our diets. Thanks!

    Hi Peggy!
    Ha! That's an awfully cheerful way to present a pretty horrible warning. Sort of like fashion advice. "Wear dark pants... they look more slimming, and they come in handy just in case you might be shitting in them during the day!"

    And thanks again anonymous for stopping by and summing it all up for us.

  24. Wow. I had no idea about the "pizza oil" leakage. Granted, I hadn't looked into it much since I haven't really considered taking it yet, but could they have picked a more disgusting term??

    Like a leaky faucet, you shouldn't leak unless there's something wrong with you!

  25. Hi Piper!
    Yeah, kinda gross, huh? And at least if you're a leaky faucet, you've got a drain right handy and you're not going to be wearing any clothes to soil.

  26. Well ive been on the precription xenical for three months now.
    Im telling you it works! I have lost 27 lbs and dont even mind the side affects.They were stronge at first but you get over it, and Sense i started taking them it has helped me to really watch what i eat. Now that i got a few pounds off now i have the energy to go for walks swim, ect.. Dont knock it til you try it! 50 lbs to go wish me luck!

  27. Oh yeah, You do need to take a multi vitamin daily, and not with the med two hrs before or 2hrs after, small adjustment, dont we all take vitamins anyway?
    Im working with my doctor to make sure i stay healthy, i do worry about the over the counter version.
    But it is only half the strenth i take.

  28. Hi Anonymous,
    That's great news that it's working so well for you! (At least the prescription version). It's good to hear that the side effects wear off over time. Sounds like you're taking a healthy approach, too, watching what you eat and exercising. I think the people who have the most trouble will be those who don't change what they're doing and expect a pill to do the work for them. Congratulations on your success!

  29. I will say this much: I take Alli and it's wonderful. As for the "treatment effects," they're seriously minimized when you take a fiber supplement -- like Metamucil -- every morning. In fact, a recent study just confirmed this commonsensical precaution I took from the beginning.

    Yes, what comes out of you body does look like the oil on pizza and will stain the toiler; however, I'm happy to know all that oil is not going into my arteries! The evidence is dramatic and immediate.

    (And, no, the evidence doesn't smell; in fact, the oil covers all matter so that no smell can be detected -- which does make me wonder whether the intestinal flora is doing its job.)

    On the other hand, seeing what has been going into my body before Alli has made me rethink my dietary habits. Too bad I needed such graphic evidence to realize it...

    Alli has changed the way I look at food -- figuratively and literally...

  30. Hi Anonymous,
    Glad you've had a good experience with it. Sounds like it's really worth it for some folks and glad the side effects went away. And that seems pretty cool that it's contributed to healthy habits. Thanks for commenting, and sorry to take so long to get back down here!

  31. I occasionally get this pizza grease discharge although I am not overweight and not taking anything. I came across this blog while researching it.


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