Alli weight-loss pill: Does it work?

Is Alli the solution to your weight-loss woes? A Mayo Clinic specialist discusses the effectiveness of Alli, an over-the-counter weight-loss pill.

By Mayo Clinic staff
Photo of Donald Hensrud, M.D.
Donald Hensrud, M.D.

Alli (pronounced AL-eye) is meant for overweight adults who are struggling to shed excess pounds. With its easy access and weight-loss promises, is Alli your answer to losing weight permanently?

Here, Donald D. Hensrud, M.D., a preventive medicine and nutrition specialist at Mayo Clinic, Rochester, Minn., answers common questions about Alli.

What is Alli?

Alli is the reduced-strength version (60 milligrams vs. 120 milligrams) of orlistat (Xenical), a prescription drug to treat obesity. It's approved for over-the-counter sale to overweight adults 18 years and older. Alli is meant to be used in conjunction with a low-calorie, low-fat diet and regular exercise.

What are the concerns with Alli?

In 2009, the Food and Drug Administration (FDA) began a safety review of orlistat because of rare reports of serious liver injury in people using it. The FDA found no cause-and-effect relationship between orlistat and the risk of liver injury. However, Alli and Xenical labels now advise people to be alert to signs and symptoms that could indicate liver injury, such as itching, loss of appetite, yellow eyes or skin, light-colored stool, or brown urine.

How does Alli work?

Alli promotes weight loss by decreasing absorption of fat by the intestines, which reduces the number of calories you absorb.

Lipase, an enzyme found in the digestive tract, helps break down dietary fat into smaller components, so it can be used or stored for energy. Alli works by disabling lipase, which prevents the enzyme from breaking down the fat while it's in your digestive tract. The undigested fat continues through the intestines and is eliminated through bowel movements.

Alli is taken with fat-containing meals, up to three times a day. Because of how Alli works, it's recommended that you eat no more than 15 grams of fat with each meal. Eating greater amounts of fat can cause unwanted effects, such as urgent bowel movements, diarrhea and gas with oily spotting.

How much weight could I lose using Alli?

Alli can help you lose weight, but the weight loss will likely be modest — perhaps just a few pounds more than you would lose with diet and exercise alone.

The average weight loss for prescription-strength Xenical is about 5 to 7 pounds (about 2 to 3 kilograms) greater than diet and exercise alone after one year. (2, 4) The lower dose Alli could conceivably result in a loss of 3 to 5 pounds (about 1 to 2 kilograms) a year in addition to the weight loss you could expect from diet and exercise alone.

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References
  1. FDA approves orlistat for over-the-counter use. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108839.htm. Accessed Dec. 7, 2011.
  2. Bray GA, et al. Drug therapy of obesity. http://www.uptodate.com/home/index.html. Accessed Dec. 7, 2011.
  3. Anderson JW, et al. Low-dose orlistat effects on body weight of mildly to moderately overweight individuals: A 16-week, double-blind, placebo controlled trial. Annals of Pharmacotherapy. 2006;40:1717.
  4. Padwal RS. Drug treatments for obesity: Orlistat, sibutramine and rimonabant. Lancet. 2007;369:71.
  5. Alli — Introducing the only FDA-approved OTC weight loss product. Alli website for healthcare professionals. http://www.allihcp.com/IntroAlli_IntroAlli.aspx. Accessed Dec. 7, 2011.
  6. Alli frequently asked questions. MyAlli.com. http://www.myalli.com/faq.aspx. Accessed Dec. 7, 2011.
  7. Completed safety review of Xenical/Alli (orlistat) and severe liver injury. U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213038.htm. Accessed Dec. 7, 2011.
  8. Xenical (prescribing information). San Francisco, Calif.: Genentech USA, Inc., 2010. http://www.gene.com/gene/products/information/xenical/. Accessed Dec. 7, 2011.
  9. Prescription medications for the treatment of obesity. National Institute of Diabetes and Digestive and Kidney Diseases. http://win.niddk.nih.gov/publications/prescription.htm#meds. Accessed Dec. 7, 2011.
  10. Anderson JW. Orlistat for the management of overweight individuals and obesity: A review of potential for the 60-mg, over-the-counter dosage. Expert Opinions in Pharmacotherapy. 2007;8:1733.
  11. Schwartz SM, et al. Compliance, behavior change, and weight loss with orlistat in an over-the-counter setting. Obesity. 2008;16:623.
  12. Smith SR, et al. Orlistat 60 mg reduces visceral adipose tissue: A 24-week randomized, placebo-controlled, multicenter trial. Obesity. 2011;19:1796.
  13. Hensrud DD (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 27, 2011.
WT00030 Feb. 11, 2012

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