Discussion about Alli
The diet pill section of the pharmacy can seem like the Wild West, as most products are considered dietary supplements and therefore not subject to U.S. Food and Drug Administration regulations. However, in June 2007, one drug became the first FDA-approved diet pill that is available without a prescription. Despite its high price tag, uncomfortable side effects, and small potential benefits, it has been flying off the shelves.

What is Alli?
Alli is a less-potent version of the prescription diet pill, Xenical (orlistat). At half the dosage of the prescription version, experts think that its potential for abuse and overall risk is low enough to be safe for over-the-counter use. You can expect to pay between $50 and $60 for a 30-day supply of Alli, which can be bought in supermarkets, drug stores, and online.

How Does Alli Work?
Put simply, Alli is a fat blocker. You take a pill with each meal. The main ingredient in the pill binds with the digestive enzymes that would normally break down fat from the meal that you consumed. Because Alli attaches to these enzymes, it prevents them from digesting about a quarter of the fat you just ate, allowing it to pass through the digestive system and out of the body, undigested and unabsorbed. Overall, fewer calories from dietary fat are stored as actual body fat.

Sounds easy, right? There’s more to it than that. Alli isn’t a magic weight loss pill, and its makers don’t claim that it is. They are adamant that daily exercise, a reduced-calorie diet, and a specific diet plan that limits the amount of fat you eat accompany the use of Alli. If you overeat on carbohydrates, protein and/or fat, you will not lose weight by taking Alli. If you eat more fat than is recommended in a single meal (15 grams or less), you’ll experience some pretty embarrassing and serious side effects (see Pros & Cons below), and still might not lose weight by taking Alli. Just like any old weight loss plan, it involves counting and cutting calories, reading food labels, limiting high-fat foods, and exercising regularly. It takes willpower, determination and consistency to see results.

What the Research Shows

 

  • Modest Results. Studies conducted by the company show that when using the Alli program (pills, diet and exercise) correctly, individuals can lose up to 50% more weight than dieting alone. They compared the Alli program with dieting only (not with dieting AND exercising), so it's hard to say whether these results come from Alli, the exercise component, or a combination of both. While 50% more weight sounds like a lot—here's an example. If you used the Alli program, you could lose 15 pounds instead of 10 pounds in the same amount of time. These results aren’t that dramatic—especially because you have to diet and exercise for it to work. In another study, dieters using the Alli program only lost three more pounds over the course of an entire year than people who dieted and exercised without taking the pill.
     
  • Less Potent than Xenical. The full-strength prescription version of orlistat, Xenical, hasn't lived up to its promise, according to data published by Consumer Reports. So is the less potent Alli any better? Data presented to the FDA suggest that the Alli program works best in those who are very overweight. In clinical trials, severely overweight subjects who took the drug for six months lost about five pounds more than those taking a placebo. In another four-month trial, moderately overweight people lost about 2 1/2 pounds more than the control group.
     
  • Short-Term Benefits. The modest benefits of Alli aren't likely to last in the long term. Alli is marketed for short-term use only, and follow-up suggests that people start to regain weight once they stop taking it.
     
  • Generally Safe. According to a GlaxoSmithKline press release, the safety and efficacy of orlistat, which has been marketed as a prescription drug in the U.S. since 1999, is supported by more than 100 clinical studies. This includes the four-year landmark XENDOS trial, the longest study ever of a weight loss medicine. More than 22 million people in 145 countries have used orlistat.
     
  • Not for Everyone. Alli is for people over the age of 18 who are overweight. It is not for people at a healthy weight, or those trying to lose the last five or 10 pounds. Other people who cannot safely take Alli include: people taking cyclosporine, warfarin, and thyroid or diabetes medication; people who have had an organ transplant; women who are pregnant or breastfeeding; people who have problems absorbing food; people with thyroid disease, gallbladder problems, kidney stones, and/or pancreatitis; people who are allergic to any of Alli's ingredients; and people taking other weight loss products.
Pros & Cons
At most, you could lose a few more ounces (1/4 to 1/3 of a pound) per week by using Alli, which is expensive and has some serious side effects. Is it really worth it?
  • You could lose more weight on the Alli program than from diet and exercise alone. But the amount of additional weight is small.
     
  • Alli's manufacturer is up front and honest about the potential side effects, which means that they won't come on as a surprise to users. Because Alli isn't a stimulant like other diet pills, it's not associated with any jitters, changes in energy levels, or insomnia. But its so-called "treatment effects" are embarrassing and negatively affect one's quality of life. Alli users experience loose stools, more frequent stools that are hard to control, an urgent need to use the bathroom, and increased gas with oily discharge. In other words, because the fat you are blocking has to go somewhere, you could experience uncontrollable diarrhea.
     
  • Alli is very expensive. Users are encouraged to take a pill with each meal that contains fat (usually lunch and dinner as most people's breakfasts tend to be low in fat). You can expect to pay between $1.50 and $2.00 per day to use Alli, or about $50 to $60 for a one-month supply.
     
  • While Alli may help you lose a few extra pounds than lifestyle changes alone, little research exists to show what happens when you stop taking Alli. Experts predict that uses will regain the weight lost since the pill is doing the extra work for them.
     
  • Although there's a lot of buzz surrounding it, Alli isn't a magic weight-loss pill. Diet, exercise, and other lifestyle changes are a must for this pill to help you lose weight.
SparkPeople's Stance
SparkPeople's experts believe that healthy lifestyle changes are the key to long-term success at weight loss and health improvements. Along with that, our fitness and nutrition experts recommend staying away from quick fixes and other unsafe or questionable practices. When it comes to diet pills, we have always advised against them. And even though Alli is FDA-approved, making it safer than any other diet pill on the market, we do not endorse it. Instead, we encourage you to discuss Alli with your health-care provider as you would any over-the-counter or prescription medication. Here's why:

Alli's "treatment effects" can seriously interfere with your daily life and well-being. You may have to take time off work, wear feminine or adult products to protect against accidents, and deal with other digestive woes. Imagine sticking to a fitness routine and everything else in your daily life while worrying about these things.

According to SparkPeople dietitian Becky Hand, Alli does interfere with the absorption of fat-soluble vitamins. It's important to take a multivitamin/mineral supplement (at bedtime) while taking Alli, but that is no guarantee that your body will still get and absorb all the nutrients that it needs—especially those that need fat to be absorbed.

Alli doesn't care whether the fat you ate was from a Big Mac or a healthy serving of salmon. Even though all types of fat aren't bad for you, Alli will take both good and bad fats out of the body. Dietitian Becky thinks this issue is "very important," despite its lack of mention in the press and in the Alli support materials. Healthy fats are important for your overall health, and blocking them can have negative effects.

According to the Alli diet, a person will take in about 450 calories from fat (50 grams) each day. "This guideline is similar to those establishes by the National Academy of Sciences," says Becky. The Alli pill will result in 25% of those fat grams (113 calories' worth) to be excreted and unused each day. Over the course of a week, the calories you save would result in about 1/4 pound lost. If you consume less fat than Alli recommends, your weight loss results will be even smaller—a matter of ounces.

"There's almost a built-in conflict of interest with using Alli," says SparkPeople Coach Dean Anderson. "You have to get the fat content of your diet up high enough for the pill to have any noticeable effect, but doing so increases the risk of side effects and pushes people towards nutrient ratios that wouldn't make any sense on a normal diet."

The Bottom Line
Taking a pill doesn't teach you how to create a healthy lifestyle that you can live with long-term. However, Dietitian Becky does praise the resources that Alli provides in their Starter Kits and online.

"Alli provides helpful tips on a variety of topics," she says. "Menu planning, cooking ideas, grocery shopping, low-fat food selections, foods to avoid, dining out, and the many benefits of tracking your food intake are all covered." By making permanent changes to your diet that you can actually stick with, you're likely to keep the weight off for good. Alli does require some dietary changes, but it isn't a long-term solution to the battle of the bulge. Dietitian Becky says that there are many reliable weight-loss books, cookbooks, resources and websites, including SparkPeople, that are much less expensive than Alli is.  "If someone really needs an expensive pill to stay accountable regarding fat intake, than Alli  may be a wise choice," she says.  "But for most people, losing only an extra quarter pound weekly is not worth the discomfort, cost, and embarrassment that Alli causes," she explains.

At SparkPeople, we realize that our members won't always heed our advice when it comes to other diet plans, supplements, or even exercise routines. "What's great about the SparkPeople program," says SparkPeople Coach Jen Mueller, "is that you can modify your trackers, learn from our helpful articles, and get support from a positive Community, no matter what diet program you choose to follow." To learn more about Alli, visit the manufacturer's website at www.myalli.com. You can also discuss Alli with other SparkPeople members on our Message Boards.

This article has been reviewed and approved by SparkPeople fitness and nutrition experts Dean Anderson, Becky Hand, Tanya Jolliffe, and Jen Mueller.