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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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June 18, 2007

Right Down the Alli

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Posted by Derek

If you're wondering why Sanofi-Aventis would spend so much time and money on a tricky, problematic drug like rimonabant, just take a look at the reception of GSK's over-the-counter version of Xenical (orlistat), brand-named Alli.

What's ridiculous about all the coverage and hype is that the drug isn't (of course) new. And it frankly wasn't all that successful when Roche sold it by prescription. So it goes OTC and everyone goes crazy for it? No, not for long they won't. From what I can see, this is just pent-up demand for something, anything, that will help people lose weight without having to work too hard.

This is not the drug to do that. And that's putting things gently. It is, as it's been rightly termed, "the Antabuse of fat". It's there to keep you on a low-fat diet, and to make you pay if you stray. If you're taking orlistat but go out and eat a bucket of fried chicken, you're going to regret that excursion for years to come. Generally, people just gradually seem to stop taking the stuff regularly, which makes it less likely to do anything, which in turn provides the perfect reason to stop taking it completely.

So my forecast for Alli is strong sales - for a while. Then it takes a dive, never to scale those heights again, as the word gets out. And the demand continues to grow for a weight-loss drug that works. . .

Comments (49) + TrackBacks (0) | Category: Diabetes and Obesity


COMMENTS

1. SRC on June 18, 2007 11:36 PM writes...

People will go to truly amazing lengths to avoid exerting themselves, either physically or morally.

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2. Morten on June 19, 2007 1:25 AM writes...

Umm... I'm lazy - what does it do?

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3. Morten on June 19, 2007 3:42 AM writes...

Not only lazy but also impatient.
From drugbank: "At the recommended therapeutic dose of 120 mg three times a day, orlistat inhibits dietary fat absorption by approximately 30%. It works by inhibiting pancreatic lipase, an enzyme that breaks down fat in the intestine. Without this enzyme, fat from the diet is excreted undigested, and not absorbed by the body."
So if your meal contains too much fat this drug would give you the s***s - am I correct? I'm not a doctor but that's not really different from the way the body works normally is it? Or do the fatties secrete extra-ordinary amounts of pancreatic lipase?
I apologize for the foul language but it is a foul subject.

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4. milkshake on June 19, 2007 4:51 AM writes...

You don't need extra pancreatic lipase to handle extra fat, the normal activity is sufficient. You actually can absorb fat from diet even with pancreatic lipase blocked - it is just takes longer and is a less efficient (diglycerides are easier to emulgate).

If you drink a few ounces of oil, the chances are that your gallblader gets rather unhappy about all the extra work done by bile pumping. (You can also aggravate the grease-induced diarrhoea by drinking very strong coffee, a known gallblader irritant).

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5. emjeff on June 19, 2007 7:47 AM writes...

I am repeatedly dismayed over the "medicalization" of obesity. Of, course, fat people have medical problems, but the idea that obesity itself is a medical condition which needs to be treated with drugs is ridiculous. People are fat because they eat too much and exercise too little, period. Stop looking for excuses and shortcuts.

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6. Demosthenes by Day on June 19, 2007 8:28 AM writes...

Obesity is the only disease/epidemic I know that has the only proven no side-effect cure. Eat less and exercise more. No FDA black box required.

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7. Kramylator on June 19, 2007 9:07 AM writes...

Not only is the drug (Orlistat)itself a mediocre method for facilitating weight loss, here again we find "medical science" barking up the wrong tree. Inhibiting fat absorption is quite useless (or even worse), since the major culprit of weight gain is carbohydrates and their effects on insulin levels (the infamous glycemic effect). Inhibiting carbohydrate absorption would be a more effective and worthy goal.

Once a person becomes sufficiently obese, it is an out-of-control medical problem that requires intervention. Metabolism, blood chemistry, liver function just for starters go severely astray. Need I point out the number of bariatric surgeries that are performed each year in the U.S.?

During the 1980's (probably when the research for Orlistat was being done), fat was the favorite obesity-causing villain, and everyone from Frito-Lay to my mother was removing fat from foods, short of chloroform extraction. The good ole' USA went on a low-fat diet and Presto!, everyone got even fatter. "Heck, this bagel has nothing in it, I can eat as many as I want, long as I don't use butter or cream cheese", I would here a co-worker say. Throw away the bagel and eat the cream cheese, we later learned, since bagels, white bread, etc. are probably weight-enhancing super pills due to the insulin blast they give you. [Insulin fluctuations promote fat storage is the over-simplified concept here] Along came the Super-Size sugar-laden soft drinks (containing enough sugar to bake a cake)and today we can go to the late-night slop joints for the medium-size bag of French fries, enough to feed a family of six. Simple carbs are cheap, and if you don't know which ones will affect you adversely, you'll eat tons of them and gain more, especially since they make you hungrier.

I, on a few occasions, used an "eating plan" which eliminated such foods as bagels, white bread, white potatoes, carrots, bananas, sugar, etc. and replaced them with moderate quantities of pasta, rye or wheat bread, and sweet potatoes, not to mention vegetables. Meat was consumed in limited quantities. After 2 weeks of this, my appetite would plummet and I would start dropping fat (and pounds) at a rapid pace without feeling hungry or tired. There was a bit more science to it (too much to describe here), but it worked like a charm each time, simply requiring discipline. Spread nation-wide, we could improve America's obesity problem quickly. Fat chance (no pun intended). Executives of food manufacturers, fast-food chains and sugar growers would have seizures if this took hold.

If drug companies wanted to create an ideal weight-loss medication, they would come up with a substance that kills sugar cravings, reduces appetite and induces the desire to cook and eat at home. Orlistat will probably become another hot inefffective has-been, like my favorite, Rogaine.

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8. Roadnottaken on June 19, 2007 10:12 AM writes...

"If drug companies wanted to create an ideal weight-loss medication, they would come up with a substance that kills sugar cravings, reduces appetite and induces the desire to cook and eat at home."

I believe that was the thinking behind Rimonabant...

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9. Jose on June 19, 2007 6:34 PM writes...

Olestra was supposed to be a breakthrough, too! Except for the whole "anal leakage" problem- and it sounds as if Alli takes it to the next level....

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10. Chrispy on June 19, 2007 9:43 PM writes...


People need to stop taking a holier-than-thou approach to weight loss. Diet and exercise would do it so stop whining is the usual line. Look -- over half the country is fat, so something is wrong. It is not that people are lazy. Actually, fat people go to enormous lengths to lose weight. They are desperate. Please be realistic and compassionate: not only is this issue probably beyond the control of the individual, it IS PROBABLY DRUGGABLE. So stop being holier-than-thou and make a goddamn drug!

Anyone who blames the victim in this doesn't really know any fat people.

Amphetamines worked great except for the addiction issue...

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11. Benjamin on June 20, 2007 9:32 AM writes...

Chrispy (Response #10) has a point about the holier than thou. The issue of weight in our society is complex. It is not as simple as eat less and exercise, but that is a major component. It is about a life style change that people need to adopt, which includes a dietary change.
Anyone looking for an easy way out, i.e, popping a pill, is not ready to make those changes.
Pharma understands that people are looking for any solution to help them lose weight...thus, pills will always be a marketed to the public.

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12. Eric Johnson on June 20, 2007 1:31 PM writes...


> Stop looking for excuses and shortcuts.

Your ancestors invented a shortcut called the bow and arrow. It replaced one called the atlatl, which was their first excuse not to spend the whole day sitting stock still on a tree branch above a deer run clutching an obsidian blade, wishing they could scratch that itch on their nose... then getting a hoof gash as they wrestled and eviscerated the deer, and being liquidated by Staph aureus 6 days later.

Philosophically, why should people suffer hunger and not suffer other things, and where and why is the fine line drawn?

> Obesity is the only disease/epidemic I know that has the only proven no side-effect cure. Eat less and exercise more. No FDA black box required.

True. And of course, for any new drug, the rarest, subtlest, and slowest side-effects (if any) are unknown, so the risks are never fully evaluable, even though one may be able to ascertain that they are very likely to be very low.

> Look -- over half the country is fat, so something is wrong.

Yes, something or some things are different. We don't know what. Perhaps a novel pathogen has spread which favors obesity. Maybe people have a deficit of reward signaling in the brain, remediable by overeating, due to changes in human communities that can make them more alienating, or due to increased anxiety following from the decline of religious belief. One could even ask whether food prices have recently declined relative to the prices of other desired goods, thus rendering evolved levels of orexia even more inappropriate than they already have been since industrialization.

Humility before nature is called for. Autoimmunity was once thought impossible. The concept of infectious etiology of cancer was scoffed at. Many truths are stranger than fiction, unless you were born and educated after they had already become truths. In the end, you can encourage fat people to exercise while still recognizing the possible existence of unknown factors that could be beyond their control. Certainly kids need to cut the video games and TV and play outside. If I had kids I would find people into canoeing and hiking who also had kids, and all but force my kids to hang out with theirs.

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13. Morten on June 21, 2007 4:11 AM writes...

Milkshake: Thanks, been wondering about that.

Kramylator: Inhibiting carbohydrate absorption would have an... unfortunate effect on osmotic pressure of the GI.

Chrispy, Benjamin, Eric: Phtalates make lab rats fat. The interplay of endocrine inhibitors are hard to track in individuals (especially if the main effect is exerted during the fetal stage) but *in my opinion* it fits well with the explosive growth in obesity and the genetic variation of susceptibility.

Still - the best diet is probably not to get fat in the first place (which is what anorectics would tell you too). After that... well probably something like the weight watchers which require the dieter to eat tons of food and tracking of how well the dieter is doing.
Exercise is best tho. Core training gives people better posture which does wonders for their looks. I just wish the social aspect of taking a work out class or doing a sport with co-workers, friends, or family would be stressed more.

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14. Chris C on June 21, 2007 10:29 AM writes...

OK, here it goes.

Those of you calling fat people lazy and undisciplined need to get off your high horse. If you had my genes, you would be fat. It runs in my family. At my heaviest I weighed 350 lbs, and I've tried everything: Jenny Craig, Optifast, Overeaters Anonymous, and of course, Xenical. The Xenical was probably a mistake in retrospect due to my frequent oily diarrhea and soiling of clothing. I did lose 70 lbs, but as Derek pointed out one's determination to put up with the side effects wanes quickly.

I had bariatric surgery six months ago (Lap-Band) and I've lost 50 lbs so far. My constant hunger has finally left me.

Try reading Gina Kolata's (NY Times) new book, Rethinking Thin; it's really excellent. Then you will be convinced that obesity is genetic.

The Lap-Band has remedied my hunger but it's come at a high price of discomfort, pain, errosive esophagitis, etc. If you could put it in a pill, it would be one of the greatest benefits to humanity.

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15. Eric Johnson on June 21, 2007 11:11 AM writes...

Morten, you have a point about sports. What's the deal with treadmills and stair climbers? If I were overweight I'd go play soccer all the time. It ain't much to look at on TV (for me), but playing it is about as much fun as you can have.

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16. Demosthenes by Day on June 21, 2007 12:57 PM writes...

I am/was not calling fat people lazy or undisciplined. That there are endomorphic body types that are "fat" is fact and THAT is genetic. The morbidly obese have to come to grips with why they eat so much. I think much more important is for a severely overweight person to get counseling to understand that. The one thing I will have a hard time believing is that sitting down and eating greater than 5,000 calories/day is genetic. If that was the case there would be examples throughout nature of creatures that did it. Overeating has a psychological component, this is also true of anorexics and bulimics which are the flip side of this. Once you are willing to face that, then eating differently and exercising more will bring you down to a healthy weight for your body type.
IMO the drug companies search for a diet pill has nothing to do with public health and is more on a par with coming up with a longer lasting ED drug. Especially when there is an option that requires no pharmacological or surgical intervention.

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17. Jose on June 21, 2007 4:01 PM writes...

I am sorry, but nutrition does not violate thermodynamics. The calories have to be ingested, and that is that- there is no magical amplification process. Obviously, once a person becomes morbidly obese, some seriously screwy and complex metabolic/hormonal pathways kick in that make it exceedingly difficult to reverse. That however, doesn't change the fact that if caloric intake >> expenditures the end result is obesity.

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18. Eric Johnson on June 21, 2007 5:55 PM writes...

> The one thing I will have a hard time believing is that sitting down and eating greater than 5,000 calories/day is genetic. If that was the case there would be examples throughout nature of creatures that did it.

Expecting humans to correspond closely to the other mammals is often misleading. The other mammals aren't allowed in the grocery store. The human allele pool may not be so well adapted yet to being able to pick up 50,000 calories in plastic bags for a day's pay. The human body arguably is not very well equipped to sense that it weighs 340 pounds. It would be sensible that one's appetite be completely shut down at that point, which it obviously is not.

There also aren't many organisms that have faced strong selection by multi-year famines, which favors storing fat. Humans presumably have faced such selection. For 10,000 years the bulk of the human population has fed agriculturally. It's likely that sociopolitical disaster led to many famines during that time (such as those associated with the 30 Years War). The human population density in agricultural civilizations is too high for people to revert to a hunter-gatherer economy during sociopolitical catastrophe.

Finally, plenty of mammal taxa can get pretty fat in captivity, despite their presumed lack of a complex psychology.

> Overeating has a psychological component

In turn, the psyche has a physical component. How are we going to trace its limits? I think it's unrealistic to claim the ability to do so at this time. Our justice system and society in general assume every day that we have free will and are guilty if we act criminally. Yet most natural scientists, if they think about it, tend towards subscribing to Laplacean determinism amended by the randomnesses quantum mechanics (apparantly) makes possible (I'm not the one to give the details on that). In other words, they think the mind basically works like a machine, arguably with no room at all for freedom of choice. In other words, billiard balls bouncing around. (Some people like Daniel Dennet try to reconcile a mechanical mind with freedom of choice - but I can't understand them, whatever that indicates.)

Anyway, there are drugs that would make you very hungry, notably the cannabinoids whose signaling is antagonized by rimonabant, but also (in many people) certain antidepressants. This can bring machine aspects of the mind into high relief, since we all agree that the input in question (a pill of the antidepressant mirtazapine) contains nothing but "billiard balls"; it presumably doesn't have a spirit or mind, whatever that is.

Epidemiology is a discipline where you build in balsa wood and school glue - or that applies, at least, to the difficult epidemiologic tasks that remain to us today. Most of the results you work with are objectionable to somebody on some account, and often quantitatively marginal to boot. You can't really quantify the overall genetic contribution to an illness - you can only quantify the heritability, which includes genes, childhood environment, etc.

But, there have been some notable attempts to very rigorously study "psychological" contributions to disease, whatever that means. For example, one study prospectively tracked the incidence of multiple sclerosis in parents whose children had died, and found an excess risk of 1.56x (PMID: 15007121). I use scare quotes above because everyone agrees that there are likely to be mid-to-long-term physical changes in the brain when your child dies, but this is still something people think of under the category of the psyche or the psycho-physical, whatever that is. Of course, MS is highly heritable and can be very toxic to cognition, so who knows whether accidental deaths or something like that could be increased in healthy members of MS families, due to some sort of subclinical neuroinflammation? With a risk ratio much above 2x, an odd possibility like this wouldn't be much of an issue, but at 1.56x it is one.

Anyway, we all know from introspection and experience that people can be lazy and indisciplined. We know eating can deliver pleasure signals and that it can take discipline to resist. Therefore, it's almost certain that a significant amount of pounds on a significant amount of people can be called indiscipline and laziness. But how significant? On which people? You and I don't know. Since obesity is on the rise, why don't we see the same rise in other phenomena, like alcohol, that also might often have a component of personal decadence?

I am not a member of the thought police or the sensitivity thugs. I hate the utopian attempt to expunge every offensive attitude from the world and institute political correctness as a neutered godhead. So I don't propose that you are bringing guilt on your head if you judge a fat person as lazy. Far from it. My point is just that you might be wrong. And that many relevant commonsense notions that seem transparent are in fact arguable. I don't suggest that radical skepticism should or can replace common sense. It's just something to think about. We don't know for sure what the increases in obesity are all about and we probably won't find out soon.

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19. Anonymous on June 21, 2007 6:28 PM writes...

"The one thing I will have a hard time believing is that sitting down and eating greater than 5,000 calories/day is genetic."

It is actually. Just that for our ancestors, BURNING 5,000 calories/day was just a normal part of hunting mammoths and fighting sabretooths.

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20. DaveH on June 22, 2007 10:19 AM writes...

Ever known an individual that can eat anything and everything they want and remain thin? I've recently read where this coccurance is attributed to specific intesinal fauna. Imagine all those hungry bacteria stealing your carbs and keeping you thin. Kinda like billions of microscopic tape worms.

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21. markm on June 22, 2007 12:04 PM writes...

Actually, for predators, scavengers, and omnivores eating well over 5,000 calories (or the equivalent for the size of the creature) in a single meal is quite normal. They often go several days or even weeks without catching anything bigger than a mouse or rabbit, so when they do have more than necessary to satisfy hunger, they eat all they possibly can before other creatures get the rest and build up some reserves for the far more frequent hungry days.

Our problem is that we can easily get all we can eat, several times a day, every day. Few of us have ever been really hungry, but we've got this instinct to go beyond satisfying hunger and eat all the food in sight, and then look for more until we're too full to drag ourselves any further - because according to our instincts, tomorrow we'll starve. Some people manage to train themselves to pay attention to the smaller signals from their body and quit eating when they've had enough for the moment - but I suspect many have so overloaded their system that those signals no longer exist.

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22. emily sheffer md on July 6, 2007 3:48 PM writes...

It seems the only discernable benefit of orlistat is the behavioral change of minimizing one's fat intake to avoid the less than desirable side-effects.

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23. Jennifer Iserloh on July 9, 2007 4:01 PM writes...

Thanks Derek- this is so interesting. As a decided warrior in the fight against obesity, I don't feel these drugs are really the answer. But let's hope they will give some people hope. I know loosing weight is hard and weight issues can stem from all different problems, including economic, social, and psychological but I have a real solution: take a good, long look at what you are eating and take responsibility. Even small changes makes a difference with or without medication.

Jennifer a.k.a. Skinny Chef

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24. Zach on July 15, 2007 10:51 PM writes...

I have been prescribed Xenical in the past and one thing I can say is I bet most people will not stay on it. I once ate some McDonald's fries while on it and ruined two pairs of my underwear. The fat that comes out reminds me of paint you find in a paintball. If you plan on eating any fat, you better also plan on camping out on the can. I am now at average weight due to exercise and changing my diet around. It is alot easier to eat better and be more active then it is to get all your exercise running to the bathroom.

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25. Melissa on July 18, 2007 1:22 PM writes...

From what I understand, this drug is designed primarily to help the people that are overweight, and those that have issues with overeating.
I am overweight, and have been all my life. My issue is not overeating. I eat less than others in my home, I don't eat junk or candy, every once in a great while I might splurge with a big mac, but everything else in my home is organic, whole foods.Although I don't eat carrot sticks for every meal, I feel that I eat sensibly. My problem is a very sluggish metabolism. I do not exercise regularly, however, I have an active lifestyle.
While I know that I should join a gym and exercise everyday, I still want someone to come up with a diet pill that will help reset my metabolism and increase the burning of calories. It seems that every new weight loss program just focuses on changing eating habits. One size fits all just never works.

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26. Jodi on July 19, 2007 9:22 AM writes...

Okay, I've read your comments, now for a question. What happens when you turn fifty and you have a bad knee, insurance companies tell you that you are too young for a knee replacement and you are stuck with a walker/wheel chair for leg movement. I ended up on anti-depressants (tried 7 varieties so far) and gained over 100 pounds after my fall. Exercise? How? My accident involved a tumble down a flight of stairs that broke my ankle, hip and knee. Weight gain is not a simple question, but figure in an aging population. I can't name a woman I know in their late 40's or 50's that hasn't had a knee replacement or ACL surgery leaving them crippled for life. Even if you eat the same as you did before the surgery the pounds pile on. Any drug that cuts cravings is worth its weight in gold to women like us. Walk a mile in our shoes (with your walker) before you stand in judgment. Xenical did not work for me because I wasn't eating that much fat to begin with. Telling women my age to exercise more, yeah, right after I run the Boston Marathon.

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27. Joan on July 19, 2007 12:43 PM writes...

I had been on a low fat diet for 3 months and also did moderate exercise (walking, dancing). I lost 10 lbs. The slow pace of my weight loss was getting extremely frustrating -- I felt like I was being tortured.

I started taking Alli 2 weeks ago and have lost six pounds. It's not a miracle -- I still have to eat right and exercise, but it's a very good aid. I have had no side effects except for a little gas occasionally.

And for the people who say you don't need any diet aids, just eat less and exercise more -- don't criticize until you've walked a mile in my shoes.

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28. Joe Rocker on August 2, 2007 7:20 PM writes...

I take it and it works like a charm. I don't even bother taking it with a low fat meal, that is a waste of pills. I went to the chinese buffet last week.

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29. Wen on August 9, 2007 11:59 AM writes...

I would like to hear more from people who have actually taken this drug and the side effects they have with the results.

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30. Gayle in VA on August 17, 2007 8:27 AM writes...

I've been on Alli since June 15th, 2007 and I'm down 29 POUNDS :o) I started at 233 lbs and I'm now at 204 lbs with 79 to go :)

I do VIDEO BLOGS of Each Weeks results and you can wacth them at www.youtube.com/fittness02

Alli DOES WORK!!!!

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31. Chris on August 24, 2007 10:51 AM writes...

I have been taking it for 3 weeks and have lost 4 pounds doing nothing different. I haven't had any side effects , either. You must have to eat like a real pig to get the bad side effects. I think this stuff works!

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32. Ash on August 30, 2007 5:49 AM writes...

"I have been taking it for 3 weeks and have lost 4 pounds doing nothing different. I haven't had any side effects , either. You must have to eat like a real pig to get the bad side effects. I think this stuff works!"

Guess you don't need to be on it if you have only lost 4 pounds so far and you don't "eat like a pig".

A few people have mentioned that the critics here must not know overweight people, much less have been one themselves...I think that must be true, because it's heart breaking to watch someone who is really desperately trying to lose weight the right way to no avail.

Maybe scientists will find something in a food preserve or a type of grease that's in EVERYTHING us Americans eat (note I acknowledged that AMERICANS seem to be the only ones severly suffering from obesity). That "something" may make us hungrier, more depressed, and more prone to fat storage. Who knows. There's a chemical in the food here (and I think England or Germany, too)that actually makes us taller than we would be eating in, say, Mexico or Asia. So if our food can make us taller, why couldn't it increase our weight gain too?

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33. Ayo on September 9, 2007 3:43 PM writes...

I have had a constant battle with my weight since I was 8 or 9. I don't have all the scientific or philosophic data to back up why I have been varying levels of fat. Lots of people don't believe I'm as heavy as I am because I'm tall (6'). Except for my weight, I'm very healthy. Low blood pressure low cholesterol nno diabetes, etc. I eat lots of veggies but I eat lots of everything. I have been diagnosed OC and in my case it's likely that my compulsive nature manifested in my not only countung steps and flipping light switches but also eating more food than is necessary. For ME until I can learn to control my behaviors, I'll never be completely normal. Although I actually like me most of the time!
Ayo
33 f 220lbs

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34. Azul on September 14, 2007 12:59 PM writes...

I had alli since end of july and have lost 14 lbs. I changed my diet a little by excluding sugars. I continued excercising as before 2-3 40min a week. I did have the mentioned side effects which were noticeable one I went to the restroom, but never had accidents during the day. I didn't get any other side effects. Actually, if you are going to be eating a meal with more than your allowed fat intake per day, I would not recommend you to have the pill to prevent worse side effects. Before I started taking the pill, I noticed very little results from the same excercise and diet routine.

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35. Wendy on September 18, 2007 7:34 AM writes...

I've been taking Alli for a couple of months now trying to take off 10 stubborn pounds that I gained from quiting smoking and I can now fit into my clothes prior to quiting. I did not have to change my eating or exercise habits because I was already watching what I ate and I exercise 4 days a week. So, I think Alli is a great aid in helping with weight loss if used correctly.

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36. Mary on September 20, 2007 9:51 AM writes...

Last week I had a routine colonoscopy which involved fasting for twenty four hours plus Fleet to clean the colon.
I was never hungry but had the same cravings I always have. My metabolism has created a confusion between hunger and cravings. Just one problem in trying to lose weight.
I used Xenical and equated it to the Exxon Valdez. It was a deterrent more than a cure. While under the care of an obesity expert I lost weight but haven't been able to keep it off - AGAIN.

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37. Hugh on September 25, 2007 12:13 PM writes...

It is funny what most skinny people will say about fat people, my only response to this is, if you think it will work then it will. If you want to be a cynical bitch then that is fine too, your choice.

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38. BOW on October 3, 2007 11:43 AM writes...

I BET ALL YOU KNOW IT ALL,S ON OBESITY DON,T HAVE AN OUNCE OF FAT ON YOUR BODIES. WALK THE WALK THEN YOU,VE EARNED THE RIGHT TO TALK!

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39. Pen on October 8, 2007 11:15 AM writes...

I started taking Alli one month ago. I've lost 10 pounds and have dealt with the oil mess problem. It has been good in the sense that it has given me a quick start and now I feel really motivated to keep losing, watch my eating and exercise. I'm stopping the pill because of all the mess and I'm eating much healthier now. It will probably take longer to lose the weight, but I can do it, without paying 50.00 a month.

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40. a love on October 9, 2007 12:50 AM writes...

if you do not use alli the way the book tells you to. Then you will have a mess on your hand'' But if you do as the book says you will be ok.It is working for me I have been on it for to weeks now and I have lost 12 pounds I eat like it says and I work out 5 days a week for just 2hours YES IT IS HARD BUT I WANT THE WEIGHT OFF" IT IS MORE OF A MIND THING. YOU MUST MAKE UP YOUR MIND TO CHANGE YOUR LIFE AND THE WAY YOU LIVE AND THINK. I TO AM BIG AND HAVE BEEN THAT WAY FOR THE LAST 9 YEARS BUT NO MORE" I HAVE MADE UP MIND THAT I WILL NO LONGER BE A SLAVE TO FOOD . IF YOU WANT THE WEIGHT OFF YOU TO CAN DO IT.JUST MAKE UP YOUR MIND THAT IT IS TIME TO MAKE A CHANGE. NOT JUST ON THE OUT SIDE BUT INSIDE YOU MUST NOT GIVE UP. WE CAN BE WHAT EVERE WE WANT TO BE IF WE JUST PUT OUR MIND TO IT. ALLI IS NOT MADE TO DO IT FOR YOU IT IS MADE TO HELP YOU ALONG THE WAY.HOW WELL IT WORKS FOR YOU IS ALL ON YOU AND WERE YOUR MIND IS IF YOU WANT TO EAT THE SAME THINGS AND HAVE THE SAME WAYS" THEN IT IS NOT FOR YOU BUT IF YOU HAVE A MADE UP MIND THAT YOU WANT TO MAKE A CHANGE THEN IT CAN HELP YOU START. THE MAKERS NAVER SAY THAT IT CAN DO IT ALL THEY SAY IT CAN HELP YOU'. AND IT WILL NOTHING IN LIFE CAN DO IT FOR YOU YOU HAFT TO MAKE UP YOUR MIND TO DO IT YOUR SELF .BUT GOOD LUCK TO YOU THAT ARE OWN YOUR WAY I HOPE YOU MAKE IT THERE.

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41. Christine on October 17, 2007 12:50 PM writes...

I was never an overweight person, until 7 years ago I had to have a Hysterectomy after the birth of my third child. In one year I gained 60 pound and over the following couple years an additional 10 pounds. I have been on just about every diet you can imagine and would drop a pound or two only to gain it back in a couple of months. The last attempt I made to loose weight included a nutritionist , personal trainer 3 times a week and very expensive over packaged food, that didn’t even taste good. The result was a whole 5 pounds in 12 weeks at a cost of about $600 per pound and a lot of hard work at the gym, not to mention being berated by some skinny little twig (the nutritionist) about only loosing 2 pounds in a month and being accused of not keeping an accurate food journal (which was accurate down to the extra fiber added to my tea).

I have been on Alli for 3 weeks and have dropped 10 pounds. I have had little treatment effects and plan to continue using Alli as long as there are results, which is more than I can say for the whole diet and exercise is enough.

And by the way when I gained 60 pounds I was running 8 miles a day 5 days a week and on a 1300 calorie diet as prescribed by the Navy because My weight was no longer to their standards.

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42. michelle on November 9, 2007 3:14 PM writes...

You know I have been thinking alot about weight. I have observed "skinny" women who eat just as much as I do and do not gain a pound. Every one I know that is over weight is STRESSED OUT. The stress may come from being depressed or having some mental illness but having a mental illness is STRESSING. It seems that those who go through life with out a whole lot of stress are the ones that can keep the weight off. I wish the FDA would study how stress effects weight retention. I mean even being TIRED stresses me out and malkes me eat. The drug ectasy eliminates stress and makes EVERYONE happy but it is illegal. I am sorry but I think the drugs that work are illegal and the ones that do not work are the ones that are legal.
Where would the FDA and doctors be if we weren't fat and sick. I dont think anything that america produces works. America is all about the all mighty dollar and I believe that if we would stop eating this garbage that America is feeding us, we would not have this problem. Like someone said earlier, we are the country with the most obesity. I visited mexico a few months ago and they do not have the problems we have regarding obesity. They still use SUGAR in their foods. America uses high-fructose corn syrup. Im telling you its the chemicals in these foods and the way they are processing them and it gets me angry.
I started using Piloncillo- it is a natural brown sugar from Mexico. I use it in my coffee. I am telling you I my digestive system got better.
I can honestly say that the foods we eat constipate us and we should be going to the bathroom way more than we do to eliminate the unwanted toxins but Americas food keeps us from going to the bathroom. I think it is all in our BOWELS- one of the reasons for obesity. We should be going more that once a day. Babies go more than once a day because they are not piling in the toxins. Especially breast fed babies.They go several times a day and are still growing and healthy. I believe in "healthy elimination" but not with "chemical laxatives because there you are putting in your body what is causing the problem to start with- chemicals. MSG- it is what America is putting in all the foods that taste SO good but MSG is killing us. MSG gives our tounge a "high" and makes us want MORE. If you want to eat healthy stop wanting foods that taste extraordinarilly GREAT and eat those that taste okay. i am thinking that all these refined sugars and MSG is just binding our colons up and keeping all those toxins in there.
did you know Mexican sodas are made with SUGAR and not High Fructose corn syrup? take a look!

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43. Corritaccs on December 5, 2007 7:19 PM writes...

I weight 346 pound. Alli offers hope and motivation. Going to weight watchers and curves 2-3 times a week. 12/1 is my first week. Will let you know if it works.

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44. Ann C. on December 18, 2007 2:29 PM writes...

I'm a middle age woman who never had any weight
problems until after menopause. EVERYTHING changed
after that. I know that I eat because of cravings,
and not hunger, which I never did. (Maybe because
my life was much different; activities of taking
care of children, and just always being on the move.) However, I am generally healthy. I have several acquaintances who are thin, but have been diagnosed with thinning bones, ulcerative colitis and other stomach problems.

THIN does not equal HEALTHY!

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45. Joe on January 4, 2008 12:51 PM writes...

Well I am down 43 pounds by doubling the dose and exercise. So it works because it forces you to change the way you eat but you need to exercise.

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46. Karen on February 11, 2008 12:12 AM writes...

Uh, most food does NOT have MSG in it, because a high proportion of the population (myself included) is very allergic to it.

Yes, MSG is a potent flavor enhancer, but it was removed from most food years ago. And you can easily avoid it by reading labels (and asking at your favorite Chinese place if they use it or not).

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47. kelli on February 29, 2008 3:54 PM writes...

IMO i think that alli can have wonderful effects. im 28, overweight, and have tried several different methods to loosing weight. i have dieted and exercised till im blue in the face, with no results. alot of people are screaming that you can take alli an do nothing else and still lose the weight. in my research, and i have done my research, u have to exercise and diet everyday to effectively reduce your weight. alli can help. the website tells you plainly that you have to exercise and diet to have a postive outcome. so all this bull about people saying alli wants you to think you dont have to do anything except take the pill is not true. it says right there in their website that you have to exercise and diet. i am willing to try this pill. it may work and it may not. my point is, everyone is different. what one product does for one person may not do for another.

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48. Rebecca on March 7, 2008 3:05 PM writes...

I am a 22 year old female who weighed 230lbs at 5'11". A year ago, i started weight watchers. i have lost 62lbs thus far but would still like to lose another 15lbs to put me at my goal weight at about 150lbs.
I started taking Alli about 3 weeks ago and it is not a pill for people who are not serious about a LIFESTYLE CHANGE. This is merely a quick fix, on the contrary, you need to practice a healthy lifestyle way before you start taking the pills to reduce your chances of having an "accident".
I have lost 9lbs in 3 weeks and continue to eat reasonably and exercise about 3 times a week. I am a very busy young professional who also goes to school fulltime.
For those of you who say you have tried everything out there and have experienced no results, stop taking shortcuts and lose weight the right way by changing your eating habits for good.
Alli has given me that extra push that i needed once i reached my plateau.

When it comes to weightloss, just like everything else in life, IF THERE'S A WILL, THERE'S A WAY.

No excuses.

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49. Allison on February 26, 2009 12:46 PM writes...

Has anyone noticed different effects with different batches of Alli? I have been taking it for a long time and had not noticed any of the unpleasant effects. I just got a new box and it seems to be "working" much better, although my intake of fats has not changed.

One benefit of Alli that has been noted, is that it cures constipation. I have been severely constipated all my life, but feel much better now that I take Alli. I have wondered if there is any correlation between the constipation and difficulty losing weight, although I have restricted my food intake most of my life.

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