Vivian Cota leaned on her shopping cart in the diet aisle of a Walgreens, recently eyeing the thick, locked plastic case labeled “Alli.”
She has tried numerous other boxes on this shelf – the green tea supplements, the 10-day Hoodia diet. And now it’s time for something new.
“I’m very interested in this,” Cota said. “You reach a plateau, and then you have to try something else.”
As Alli, the first FDA-approved diet drug cleared for over-the-counter sale, arrived in drugstores earlier this tear, doctors and nutritionists are trying to counter that intense consumer interest and a marketing juggernaut with some spin of their own, arguing that the drug’s high cost and limited effectiveness may not be worth its notably unpleasant side effects.
Alli (pronounced “ally”), sold by GlaxoSmithKline, is a half-dose of the prescription drug orlistat. The drug has been marketed in prescription form by Roche Holding AG under the brand name Xenical since 1999, but it never turned out to be a blockbuster.
GlaxoSmithKline, however, expects Alli to ultimately rake in at least $1.5 billion in annual sales, and the company is expected to spend $150 million on marketing the drug in its first year. Television and magazine ads are already running. E-tailers Amazon.com and Drugstore.com report that the drug is a top seller.
Alli blocks enzymes that digest fat, preventing the body from absorbing about a quarter of the fat eaten. The undigested fat is then excreted. One study of Alli showed that dieters who took the drug along with diet and exercise over a year lost about three pounds more than people who only dieted and exercised.
The company’s message is that the pills, typically taken three times a day, are not a “magic bullet,” and officials urge users to use Alli only along with exercise and a reduced-calorie, low-fat diet.
Because Alli can interfere with vitamin absorption, it can affect how medications act in the body, and users are advised to take a multi-vitamin supplement. The drug is not recommended for children younger than 18, people with kidney disease, patients on blood-thinners and certain other medications, and pregnant or breast-feeding women.
Then there are the side effects, which can include oily discharge, diarrhea and uncontrollable bowel movements significant enough for the company to recommend carrying an extra pair of pants until users have accommodated to the drug. The side effects alone can force users to eat less.
“We’re skeptical about something like this going over the counter,” said Dr. Rohini Ashok, a Kaiser Permanente-Santa Teresa, California, physician and a leader of the HMO’s new, doctor-supervised weight loss program. “It’s not an unsafe drug, but it’s not benign. The side effects are pretty gross.”