Dear DOCTOR Owen:

My doctor recommended that I take Xenical®. I am 65 years of age, 5'8", male, and approximately 50 pounds overweight: Body Mass Index (BMI = 33). He suggested that I use this instead of a cholesterol medication because he thought it might help the cholesterol and help me lose my potbelly. What do you think?

Fat Blocked

Dear “Blocked”:

Your doctor is thinking of a “two-birds-for-one” stone. He is also thinking of safety. Orlistat, trade name Xenical®, is a fat blocker that prevents fat absorption in the gut. I have been saying that, in a few years, Xenical® may become the first line of treatment for high cholesterol. By blocking the absorption of dietary fat (30%–50%), that fat goes out with the stool instead of to the hips or arteries.

Xenical® is virtually riskless because it is not absorbed into the bloodstream. Fat is risky, as it goes directly into the bloodstream. In addition to raising blood fat levels (cholesterol and triglycerides), the fat is processed through the liver—the main site of cholesterol production in the body. Even small amounts of fat in the diet can stimulate the liver to make cholesterol in patients with susceptible genetics.

If you can decrease the direct amount of fat entering the blood and the amount stimulating the liver, you can hand a “one-two punch” to the most common cause of death and disability in the world: atherosclerosis.

Seven in ten of us who live past 40 will die of cholesterol, so any impact on this statistic will be of great importance.

In addition to the cholesterol risk, the 50 pounds of fat in and around your belly are dangerous. For every 10 pounds of extra weight around the belly, there is an extra 500 pounds of stress along the lower lumbar vertebrae. It is not surprising that obesity is the number-one contributing factor to low-back disability. Low-back pain is the costliest disease in the United States. While atherosclerosis is also very expensive, your cost to society becomes nil when you die.

In a study at Hoffman-LaRoche, published in Obesity Research, Vol. 7, No. 1, 27S, researchers found that elderly individuals averaged a 10% decrease in both total and LDL (lower density lipoprotein), or bad, cholesterol. For the average American, this equals a total drop of 20 points, which is very significant! The patients using Xenical® lost the expected average 10% weight, or 20 pounds. The loss of 20 pounds off your belly will have a favorable effect on your back.

The only side effects of Xenical® are diarrhea and price. The loose stools abate in most people with time as the gut accommodates the fat load. The cost is usually not borne by most insurance because Xenical® is released as a weight-loss drug. (Tongue in cheek): Of course, the insurance companies “know” that you’d be able to control your fat intake and your weight if only you had more willpower and a stronger character! I predict that the insurance coverage will change as the harmlessness and effectiveness of this drug emerge from the data.

All of the studies reveal that a change in diet and exercise patterns should accompany Xenical® use. I concur. Several medications on the market are very useful in reducing cholesterol, but have no effect on weight. Xenical®, a nice alternative, may also be used with cholesterol medications for patients who are resistant to those medications.

Warning! Do not pass gas anywhere except in the bathroom when first starting to take Xenical®—nor take a slow boat to China! You will have a sharp learning curve as to what contains fat and what doesn’t—and the consequences are often immediate!