Want to lose weight? Don't count on pills

By Debra Sherman

CHICAGO, Jan 22 (Reuters) - Users of Alli, the first weight-loss drug approved for sale over-the-counter in the United States, are finding what they likely suspected all along: pills are no magic substitute for diet and exercise.

Yet as Americans engage in the New Year's tradition of resolving to shed pounds, the market for diet aids is expected to remain firm, even as the economy is mired in recession.

Americans spend $30 billion a year on weight-loss products and services, and two-thirds of the population is overweight or obese.

GlaxoSmithKline's Alli (GSK.L), a lower-strength version of Roche's (ROG.VX) prescription-only Xenical, created' a stir when it was approved 18 months ago.

Since then, it has become known for its unpleasant side effects, including incontinence, diarrhea and flatulence with "oily spotting."

"It works to inhibit absorption of fat from our diet. Therefore the fat comes out in the stool, causing diarrhea, which patients don't like much," said Shirley TerMolen, a Chicago internist.

Because the side effects result from eating too much fat, TerMolen noted that some of her colleagues use the drug to help patients modify their behavior.

TerMolen said she has prescribed the drug but has not seen a lot of success. "For most people, they're just looking for a shortcut instead of just eating better and exercising," she said.

Donald Hensrud, a weight management specialist at Mayo Clinic, called the gastrointestinal side effects overstated. But, he added, the intended effect "is also overrated."

"People who took the drug lost only 4 more pounds (1.8 kg) than the placebo group after a year. People have to ask themselves whether the expense of this medicine is worth a few extra pounds," Hensrud said.

A 30-day supply of Alli costs $60.

People who took Xenical, the prescription strength version, lost an average of 5 to 7 additional pounds (2.2 to 3.2 kg) after a year compared with those who took a placebo.

Still, experts say weight loss of 5 percent to 10 percent is a worthy goal and a point where health improves.

Meanwhile, Alastair Wood, who chaired the Food and Drug Administration advisory panel that reviewed Alli in 2006, said he's not convinced the drug is being used by the people who would benefit most. In some cases, it is abused by people with eating disorders, he said.

"It's a juxtaposition of an epidemic of obesity with the hope and expectation that we can treat it pharmaceutically," said Wood.