Alli, the lower-dose version of the prescription-only weight loss drug xenical, went on sale in U.K pharmacies on Wednesday. Alli has been available from pharmacies in the U.S since 1998 where it is a big seller for GlaxoSmithKline.
Alli - medical name Orlistat - has been the focus of a great deal of discussion in the media as to the wisdom of letting people buy weight-loss drugs without consulting a doctor first, with medical experts and media pundits weighing in on both sides.
Makers GlaxoSmithKline have said that the pill is designed for patients with a BMI (body mass index) of 28 or more. GSK ran clinical trials on the medication which they claim shows obese people can lose 50% more weight than they would through dieting alone. Orlistat works by blocking the action of an enzyme in the gut that causes fat to be broken down, allowing it to pass into the bloodstream. The undigested fat then passes out of the body as waste. The lower-dose version uses the same mechanism as Xenical but is less strong than the original formula, which is still only available with a doctor's prescription. Xenical is one of only two prescription-only weight loss pills that can be obtained in the UK, the other being Reductil, which reduces the desire for food.
Part of the concern provoked by the over-the-counter sale of Alli has been caused by the side-effects that some patients experience when taking orlistat. Though generally controlled if the patient sticks to a low-fat diet - meaning that their daily calorie intake is only made up of less than 30% fat -, side effects can include flatulence, oily stools and even uncontrollable bowel movements. In America, these have come to be known as the "Alli-oops" moment.
Advice has been issued from the Royal College of GPs that the pills should only be used with medical support and dietary advice, but if the patient is going to the pharmacy rather than the GPs surgery it is fairly likely that a large proportion of those buying the pills will not seek any more advice than that given during the initial conversation with their pharmacist. The Royal College said that consulting with a doctor in addition to taking the pills was important as in some cases there may be causes for the weight problems other than lifestyle. It is also important for obese patients to be aware of their higher risk of developing illnesses like diabetes and heart disease.
However the National Obesity Forum has welcomed the move, saying that though it is not a magic bullet, it has been proven to help with weight loss. The Royal Pharmaceutical Society has pointed out that many pharmacists already offer customers help with managing their weight and believe that Alli will provide them with one more way to fight the obesity epidemic.
Obesity experts have said the current number of Brits who have a BMI of over 28 means that we are currently in the grip of a fat crisis - and it's only expected to get worse. Researchers have warned that if current trends continue, 40% of the population will be obese within three years. As the NHS and doctors rack their brains to come up with a way to get people to change their lifestyles, it will be interesting to see if making slimming pills more accessible helps the situation.
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