Dear DOCTOR Owen:

I am interested in using Xenical® (Orlistat) for weight loss. Are there any long-term side effects with this drug? How does it work? I plan to make some lower-fat eating choices in my diet as well, but we constantly go out to eat with friends and family.

Social Susan

Dear “Susan”:

There are definitely side effects with Xenical®: lower cholesterol, lower blood pressure, lower blood sugar, lower insulin levels, and lower weight. How does that sound? In fact, the medical improvements are more striking (to me) than the effects on weight!

In most studies, people who want to lose weight have very high expectations of themselves. Most of them expect to lose 38% of their initial weight in commercial diet programs; average weight loss in aggressive commercial programs is 14%. We scientists realize that even 10% weight loss causes substantial improvement in medical conditions and risk.

Long term, it is found that more people will make changes in their diets and exercise habits for health reasons. Short term, it is found that they could care less—they just want results! People want to “feel better” physically and emotionally, and they “think” that losing weight will accomplish that goal. Both the long-term and the short-term goals are important, and we diet and health counselors must consider both when counseling people about losing weight and accomplishing long-term control.

Researchers comprising the European Orlistat Obesity Study Group (from multiple countries), reporting in Obesity Research, Vol. 8, No. 1, 49–61, released findings of a two-year trial of Xenical® on weight and cardiovascular risk factors. They compared a group of patients placed on a low-calorie diet with a group on the same diet plus Xenical®.

Compared to the group not on Xenical®, the Xenical® group:

• Lost 5% more weight.
• Kept off the weight at two years.
• Had a marked lowering of cholesterol, blood pressure, glucose, and insulin.

 This confirms previous studies, which show that modest weight loss will have profound effects on risk factors. Since Xenical® blocks the absorption of fat in the diet, it is not surprising that cardiovascular risk was reduced. No fat entering the blood equals less fat available to block the arteries.

The only negatives about Xenical® are loose stools and gas that may result from the extra fat in the stool; these side effects seem to diminish with time, however. Only 3% of the patients on Xenical® dropped out because of the side effects—the same number as in the non-Xenical® group.

For a medication that has no systemic side effects, I think that the results are profound. Everything I prescribe has side effects. While the diarrhea can be troublesome, most people can usually put up with it until it goes away. I have had some patients lose much more than 5% of their weight on Xenical®.

Hopefully—as more studies emerge—the cost of Xenical® will decrease or be covered by insurance. These results are almost as good as those of other cholesterol medications. It is a Catch-22 situation: More studies are necessary to prove that Xenical® helps medical problems—not just weight. However, studies cost serious amounts of money, which further “jack up” the cost that the manufacturer must charge. Of course, the government, which claims that the drug manufacturers are gouging the public, drives those mandates!

Many of my patients make trips to Mexico to buy medicine. The government and lawyers in that country have not yet have not yet aggressively intruded into people’s privacy. The cost there is one-quarter that of the same medications in the United States.

Give the Xenical® a three-month try. Have your physician follow the cholesterol, blood pressure, and blood sugar risk factors. I am certain that you will find the health improvements helpful in your long-term motivation.