Fat Blocker Drugs

By:
Jonny Bowden

Oh, if it was only that simple.

I can understand the excitement. I can understand the need. You tell me that you've got a pill that will let me eat whatever I want with little or no waistline-expanding consequences and I'll do two things immediately: 1.) place a jumbo order and 2.) call my broker to buy shares in the company making it.

Or at least that's what I would've done when I still believed in Santa.

The New York Times article announcing that the FDA had approved Orlistat, a "fat-blocking, anti-obesity" drug by Hoffman-LaRoche, was greeted with enthusiasm by many segments of the public. They continue to hope, understandably, that modern science will soon provide the technology to make losing fat easier than undertaking a major lifestyle overhaul. But if you read the reports a little more carefully, you might want to think twice before running out and searching for a doc who will prescribe it.

Orlistat, which will appear in the next few weeks under the trade name Xenical, works in the GI tract by blocking the action of a fat-digesting enzyme. About one third of the fat someone eats will, instead of being digested, accumulate in the intestines and be excreted.

Now that you know how it works, the first problem with using Orlistat (Xenical) for fat reduction should be immediately apparent: It does nothing to the fat you've already accumulated. Orlistat works only on "incoming" fat in the diet -- preventing, I will repeat, only a percentage of it from going to your hips. At best, it would decrease slightly the consequences of continuous bad eating.

Hope for Losing Weight

But even this is not 100 percent clear, nor does it come without a price.

For one thing, by blocking the absorption of fat, the drug also interferes with the absorption of vitamins A, D, E and K, as well as beta-carotene -- all of which are fat-soluble. For another, Orlistat is known for producing side effects such as flatulence, bloating and, most famously, what is euphemistically referred to as "anal leakage."

Lovely.

Even so, some folks might think it's worth the price. After all, what's a little bad timing in the bathroom-behavior department compared to the ability to zap those last 10-20 (or more) pounds, once and for all?

Well number one, the drug was approved only for "seriously overweight" people -- those who meet the government's "over 30 percent overweight" standard for obesity or those who have diabetes, hypertension and high cholesterol in addition to being 20 percent overweight. We can be pretty sure that that recommendation won't keep doctors from prescribing it for people who don't fit that profile, just as they did with phen-fen. Number two, even in trials the results were pretty underwhelming: In one study, there was only a four percent difference in body weight between the group taking the placebo and the group taking the drug. And in an experiment reported in the January JAMA (Journal of the American Medical Association), many people who were taking Orlistat began to gain weight back after a year, even while continuing to take the drug.

Advanced Methods

Magic bullet? Sorry.

What's interesting to me is that the health food industry has long had a product out on the market that works, in basically the same way. It's called chitosan and it too works by preventing the absorption of some of the fat in the diet. According to Earl Mindell, a leading authority on supplements, as chitosan "passes through the digestive tract it can absorb four to six times its weight in fat, thereby flushing it out of the body before it can be metabolized and stored as excess pounds." But because it has the same problems as Orlistat, no one really thinks it's a major player in the weight loss field, and the same caveats ("Anal leakage," anyone?) apply.

With the inevitable hoopla you'll be hearing about this brand-new drug, it's worth remembering that there's a bit of cash involved here. With recommended use at three times a day for a year or more, and an expected price of $1.10 a pill, yearly use can run up to $1,204.50 per person. Chitosan costs about $49 for a two month supply, which works out to about 80 cents a day -- considerably cheaper (about 28 percent) than its more expensive pharmaceutical cousin.

Forewarned is forearmed. Bring along your fat-soluble vitamin supplements, some extra toilet tissue, a fair amount of cash, and some lowered expectations.

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