Losing weight can be a significant challenge for many individuals. Factors such as disease risk reduction, improved quality of life, and management of disease-related symptoms often motivate people to shed excess pounds. However, the path to sustainable weight loss isn't always straightforward. Calorie restriction can trigger compensatory changes in the body, including increased appetite and reduced energy expenditure, making it difficult to maintain weight loss over time. This has led many to explore alternative weight loss methods, including medications and supplements like Alli.
Alli (pronounced AL-eye) is an over-the-counter (OTC) drug designed for overweight adults seeking to lose weight. It contains 60 milligrams of orlistat, a lower-dose version of the prescription drug Xenical, which contains 120 milligrams of orlistat. The Food and Drug Administration (FDA) has approved Alli for use in adults 18 and older with a body mass index (BMI) of 25 or higher. Xenical, on the other hand, is approved for adults with a BMI of 30 or higher, classifying them as obese.
How Alli Works
Alli's active ingredient, orlistat, functions by inhibiting lipase, an enzyme in the digestive tract responsible for breaking down dietary fat into smaller components that can be used or stored for energy. When Alli is taken with a meal, it blocks the action of lipase, preventing approximately 25% of the fat consumed from being broken down and absorbed. Instead, the undigested fat is expelled from the body. By reducing the amount of fat absorbed, Alli helps to lower calorie intake, potentially leading to weight loss. As a lipase inhibitor, Alli has been shown to reduce the absorption of dietary fat by about 30%.
Recommended Use of Alli
The recommended dosage for Alli is one 60-milligram pill taken within an hour of a fat-containing meal, up to three times a day. It is important to spread daily fat intake evenly across the three main meals, ensuring that fat constitutes no more than 30% of total calories. If a meal contains no fat, a dose of Alli is not necessary.
Effectiveness of Alli
Alli can be part of a weight-loss plan that includes diet, exercise, and drug therapy. A weight-loss plan with diet, exercise, and drug therapy is generally considered successful if you lose about 1 pound (0.5 kilogram) a week during the first month. If the treatment is successful, you are more likely to keep weight off or lose more weight if you continue with the diet, exercise and drug treatment plan. Most weight loss with the drug occurs within the first few months. If you haven't lost 5% of your body weight within a year on the plan, stopping the drug would be a reasonable choice.
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While Alli may aid in weight loss, the results are often modest. Clinical studies have shown that over 40% of individuals taking Alli, while adhering to a calorie-restricted diet and increasing physical activity, experienced a 5% or greater reduction in their body weight within a year.
The most well-known study is the Swedish XENDOS study, published in 2004, which included 3,305 people with obesity over 4 years. During the first year, the average weight loss in the orlistat-treated group was 23.3 pounds (10.6 kg), while the placebo group lost only 13.6 pounds (6.2 kg). Orlistat-treated patients ended up having lost 12.8 pounds (5.8 kg), compared to 6.6 pounds (3.0 kg) in those receiving a placebo.
According to a research review, the average 12-month weight loss for adults taking orlistat while participating in behavioral weight control programs and following a low fat diet is about 7.5 pounds (3.4 kg) greater than placebo (5). Orlistat 60 mg (the Alli dose) specifically showed an even smaller average weight loss of 5.5 pounds (2.5 kg) compared to the placebo group.
Additional Health Benefits
Alli has also been linked to several other health benefits due to its effect on weight loss:
- Reduced risk of type 2 diabetes: The XENDOS study found that 4-year use of orlistat reduced the risk of developing type 2 diabetes by 37%.
- Reduced blood pressure: A 2020 review of 27 randomized controlled trials found that weight loss induced by orlistat was associated with reductions in blood pressure in people considered overweight or obese.
- Reduced LDL ("bad") and total cholesterol: A 2017 review of 33 trials found that orlistat slightly reduced cholesterol and triglyceride levels, but the reductions were more consistent in people who lost more weight and took orlistat for a shorter time.
Side Effects of Alli
Alli diet pills do have well-documented side effects, some of which are quite unpleasant. The active ingredient in Alli, orlistat, causes digestive side effects related to undigested fats passing through your digestive system. They generally lessen over time and with proper use of the drug. Some of the most common side effects of Alli are:
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- Digestive symptoms: The presence of undigested fat in the bowel can cause digestive symptoms such as abdominal pain, diarrhea, and flatulence. Some people also experience fecal incontinence and loose, oily stools.
- Impaired nutrient absorption: Continued use of Alli can impair the absorption of fat-soluble nutrients such as vitamins A, D, E, and K, leading to nutrient deficiencies. It can also decrease calcium absorption.
- Increased risk of kidney injury: Alli could increase the risk of kidney issues because the unabsorbed fat binds with calcium in the digestive system. This can cause calcium oxalate crystal deposits to develop in the kidneys, leading to kidney injury.
- Drug interactions: Alli may also interfere with the absorption of some medications, including drugs used to treat conditions such as epilepsy, thyroid conditions, irregular heartbeat, and HIV.
Between April 1999 and August 2009, there were reports of liver injury involving the use of Alli and Xenical. However, it's unclear whether orlistat was completely to blame for causing liver injury, as some people who experienced this rare side effect were using other medications or had medical conditions that may have contributed to the development of liver injury.
Important Considerations Before Taking Alli
Before taking Alli, it is important to consult with a healthcare professional, especially if you have any medical conditions or are taking medications. Alli is not suitable for individuals with malabsorption, eating disorders like anorexia or bulimia, or cholestasis (a condition that impacts the flow of bile from the liver). It should also be avoided by pregnant or breastfeeding women and children.
Alternatives to Alli for Weight Loss
While Alli may offer some assistance in weight loss, it is not a magic bullet. Sustainable weight loss is best achieved through a combination of healthy eating habits and regular physical activity. Consider the following strategies:
- Cut back on ultra-processed foods: Focus on whole, nutrient-dense foods such as vegetables, fruits, nuts, beans, and fish.
- Increase protein and fiber intake: Protein and fiber can help you feel fuller and more satisfied, reducing overall calorie intake.
- Reduce added sugar intake: Limit sugary drinks and processed foods high in added sugars.
- Cook more meals at home: Home-cooked meals tend to be healthier and lower in calories than restaurant meals.
- Increase activity levels: Find an activity you enjoy and make it a regular part of your routine.
- Work with knowledgeable healthcare professionals: Consult a registered dietitian or other healthcare professional for personalized guidance.
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