Fat-busting pills go on sale over the counter

Published on Monday 20 April 2009 22:08

THE first over-the-counter drug to help weight loss goes on sale in the UK tomorrow, amid calls to ensure responsible use.

The drug, alli, the active ingredient of which is orlistat, can help adults lose 50 per cent more weight than by dieting alone.

But pharmacists warned the treatment should be handed out only when clinically appropriate and after a proper consultation with the patient.

Campaigners also expressed concern about children getting hold of the drug believing it was a simple answer to their weight problems. Alli is not licensed for under-18s.

Alli works by stopping about a quarter of the fat consumed in each meal being absorbed into the body.

Trials show it can help slimmers lose 50 per cent more weight than if they simply diet, so for every 2lb lost by dieting, alli could help them lose 1lb more.

But experts – including the drug's makers, GlaxoSmithKline – point out that it is not a "magic bullet" to cure obesity. Patients have to follow a low-fat diet, or risk unpleasant effects due to the amount of fat passing through the body.

If too much fat is consumed, patients may be unable to control their bowels, causing embarrassment in public places.

A four-week supply of alli costs 49.95 while two weeks' supply will be sold at 32.95.

Tablets will be available to adults with a body mass index (BMI) of 28 or over, following a quick consultation with a pharmacist. A BMI of 28 is classed as overweight while over 30 is obese.

BMI is calculated by dividing a patient's weight in kilograms by height in metres squared.

About a quarter of adults in Scotland are classed as obese.

Orlistat has previously been available on prescription, under the trade name Xenical, used at a higher dose than alli.

Figures last month showed more than 110,000 prescriptions were written in 2007-8 for weight-loss drugs in Scotland – up 6,000 from the year before.

James Hallatt, general manager of GlaxoSmithKline Consumer Healthcare UK, said obesity and weight issues were a major concern for society.

"Alli is not a magic bullet – users must be committed to weight loss," he said.

Mr Hallatt said alli had launched in the United States in 2007 and had been well-received by millions of people.

Andy Murdock, governance director at Lloydspharmacy, said he was concerned that some people might be able to get alli although it is unsuitable for them.

"It's important that all sectors of the pharmacy profession uphold the very highest clinical standards when providing this treatment," he said.

"A number of GPs have said they are very worried that alli may be sold to people for whom it is clinically inappropriate.

"I am calling on all colleagues to maintain the very highest standards when the service begins and not to let the desire to please the customer override clinical considerations."

Pharmacies across the UK have been training staff to sell the treatment.

Tam Fry, chairman of the Child Growth Foundation, said people should also be aware that alli was not suitable for overweight children. "Our fear is that mothers and fathers of overweight children will go to the chemist, get a supply of alli, then say to the children 'have one of these before each meal and you'll be fine'.

"That is absolutely the wrong thing to do."

Mr Fry said: "If they don't follow that up with lifestyle messages the child will be going to the toilet every five minutes with diarrhoea."

Mr Fry said another concern was people stockpiling alli by going from one pharmacy to another, with the potential for it to find its way into schools.

He added: "Children need fat in their diet for development, so we need to watch this carefully."

Glasgow GP Gary Hamilton reiterated the point that alli was not a quick fix for obesity and questioned what the long-term effect of the drug would be across the whole population.

He said although people lost more weight while on the drug, without long-term lifestyle changes they tended to put it back on once they stopped.

HOW THEY WORK

1 Patient goes to pharmacist for consultation to see if they are suitable to buy alli over the counter. Patient should have body mass index of 28 or more, and be over the age of 18. Pharmacist should make sure patient is aware of need to follow a low-fat diet to avoid side-effects and maximise chances of losing weight.

2 Patient takes one capsule of Alli, three times a day at mealtimes – before, during or up to one hour after each meal.

3 Capsule dissolves in stomach. Active ingredient in alli – orlistat – attaches itself to some of body's enzymes that break down fat. This prevents enzymes working and some of fat being digested and absorbed.

4 Fat in the diet is usually first emulsified in the stomach before being further broken down by pancreatic enzymes (lipase). Fat is then absorbed via the lymphatic system before entering the bloodstream and being distributed around body.

5 In patients who have taken alli, around 25 per cent of fat in each meal passes naturally out of the body in stools.

6 Patients who continue to eat a diet high in fat will pass larger amounts of fats when going to toilet. This can lead to side-effects such as wind, sudden bowel motions, fatty or oily stools, and loose stools.

CHANGE IN LIFESTYLE VITAL TO MAKING DRUG WORK AND NOTICEABLE WEIGHT LOSS

JIM Douglas started taking alli five weeks ago as part of a trial ahead of the drug going on sale and has been impressed by the results.

But the economic development officer, from Houston, near Paisley, said it was vital that people knew that the treatment only worked if lifestyle changes were made as well.

Mr Douglas, 46, had previously been told by his doctor that he was "a heart attack waiting to happen".

"I had known it was a problem for a while and it was just a case of starting to try to sort it out.

Before starting on alli, Mr Douglas weighed 18 stone 1lb. He is now down to 16 stone 12lb.

He said he was aware that alli would not work without him making changes to his diet.

"It is not a wonder drug. There has to be a lifestyle change," he said.

"I have been on a low-fat, low-calorie diet and I have been doing more exercise, which is I think why it is working so well for me."

Mr Douglas said he was now starting to see physical changes, with weight lost around his waist and face.

"I have still got a couple of stone to lose so I am going to continue taking it.

"You can take it for up to six months, but that is the limit."

Drug can only work with a big effort from the patient

Professor Mike Lean

ORLISTAT has been available over the counter in other countries for many years. It is a very safe product, in that it is not absorbed into the body, so it has no direct side-effects. It blocks the absorption of about a third of the fat from your diet, so it can have effects.

People must understand that it produces minimal weight-loss, unless you are making a big effort. What it does is give you a "leg-up" if you are on a diet and exercise programme and cutting down fat to lose weight. It does have a small extra effect of cutting cholesterol as well. But you have to make the big effort – the drug will not do it for you.

To beat a weight problem, you have to cut down on fat in your diet in a way that you maintain throughout your life. It is no good playing around with a drug for a short time and putting the weight back on.

If people are concerned about their weight, it is very simple. Measure your waist, just between your lowest rib and the level of your hip. If your waist has reached 37in if you are a man, or 32in if you are a woman, you have too much body fat.

If you have reached 40in (men) or 35in (women), then you have a serious problem, and taking a safe drug can be justified if you are prepared to make a long-term effort.

You should have been doing something before you reached this point, but it is not too late to make changes.

• Mike Lean is professor of human nutrition at the University of Glasgow. He is also a consultant physician at Glasgow Royal Infirmary.