Taking the load off, with a pill

Taking the load off, with a pill

When looking to lose weight, when is it OK to use fat-blocker medications?

SOCIAL & LIFESTYLE
Taking the load off, with a pill
An online ad for fat-blocking supplement. www.youtube.com

Although Natcha* had the Body Mass Index (BMI) of an underweight person, she was usually worried sick whenever she would have a bite or two of fatty foods. But for the then-29-year-old office worker, those dishes were always hard to resist.

"We know these foods will make us fat, but sometimes we just can't help it. We really want to eat them," she admitted.

One day, Natcha desperately craved kha moo but just couldn't stand the fats from the braised pork leg going inside her body. Her solution was fast and easy: taking a pill that would block those fats from being absorbed. "I had known about this medication for a long time but never tried it. People said it blocked fats from entering the body, no matter how much we eat. So I just thought, 'Why not?'."

And it worked. "Drops of oil came out with the stool. It wasn't much but it was noticeable."

Natcha is now 46 years old yet still has the BMI of her younger years. "Back then a lot of people I know took the pill because they wanted to eat pizza and all that junk food. Looking back, I don't understand why we didn't just cut those greasy foods instead of depending on a quick-fix like the fat-blocker."

The fat-blocker pill has actually been around for decades, but returned to the public spotlight recently when a fat-blocker manufacturer released a nearly four-minute-long commercial -- featuring actress Wirithipa "Woonsen" Pakdeeprasong -- that has gone viral only a few days after launch. Though the commercial was given a thumbs-up by many for its creativity, it has raised many eyebrows in terms of the supplement's effectiveness and possible side effects.

Clinical nutrition specialist Dr Phaisit Trakulkongsmut said that when it comes to fat-blockers, the only drug allowed for sale and use in Thailand is Orlistat. Marketed here under the trade name Xenical, Orlistat is a medication, not a supplement.

"Orlistat is a very safe drug," said Dr Phaisit. "It is approved by not just the Thai Food and Drug Administration [FDA] but also the FDA in the United States. In the US and other Western countries, this medicine is prescribed for people with a BMI over or equal to 30 -- which suggests obesity -- as well as people with a BMI greater than or equal to 27, with diseases like diabetes, high blood cholesterol and high blood pressure."

As for Thai people, added the specialist, Orlistat is suitable for those with a BMI over or equal to 25 -- a sign of obesity -- and those with the BMI over or equal to 23, which means overweight.

In terms of mechanism, Orlistat prevents lipase -- an enzyme that digests fats -- from functioning, which in turn leads to fats not being absorbed, given that their molecules are still large. But this does not mean all fat intake would not be absorbed, as Orlistat blocks only 30% of consumed fats, leaving the remaining 70% to still find its way into the body.

"This means that even though you take Orlistat but fail to control your diet, you take the medication to no avail. Numerous clinical studies recommend that people complement Orlistat with diet control and regular exercise," said Dr Phaisit, adding that common side effects of the drug include oily stool, the inability to hold the bowel movement, flatulence and nausea, which would last only a week or two after beginning the medication.

A large number of supplements available both in the on- and offline markets claim they are able to block fat-absorption. According to Dr Phaisit, there is no such thing as a fat-blocker supplement. Fat blockers are only available in the form of medicine.

"There is no supplement that could block fat absorption and subsequently cause oily stool," Dr Phaisit assured. "Some manufactures, however, put fat-blocker medication in their supplement products. Random surveys by Mahidol University once found Xenical in their tested subjects."

Adding fat-blocker medication to supplements and claiming the products have medicinal effects is actually against the law, subject to a maximum 5,000 baht fine according to the Food Act B.E. 2522 (1979). And if the products involve false advertising, manufacturers are subject to a fine of 30,000 baht and/or three years' imprisonment.

In spite of false claims from supplements, there is good news: fat-blocker medication does not cause fatal side effects, said Dr Phaisit. Taking a full dose of Orlistat for over two to three consecutive months could put consumers at risk of developing fat-soluble-vitamin deficiency.

"Orlistat is available over the counter. But instructions [as to how to take it properly] should be given by a pharmacist. If taken long-term, Orlistat can cause vitamin E, D and K deficiency. People who take Warfarin [medicine that prevents blood clots] should be careful when taking Orlistat, as the lack of vitamin K -- plays a key role in helping with blood clots -- might potentially lead to bleeding."

"Fat-blocker drugs do not themselves bring about life-threatening side effects, but the lack of certain vitamins as a result might leads to other health consequences, such as low immunity and increased risk of cancer," said Dr Phaisit, adding that Orlistat can also have liver-related side effects. In some countries, it is compulsory that drug manufacturers state in their product leaflets that Orlistat must be discontinued immediately following jaundice and dark urine -- a sign of liver inflammation.

Weight-loss pills and supplements are largely available and easily accessible these days, especially on the internet. Sadly, every now and then we see cases of people developing severe unwanted side effects, sometimes dying, after taking these products. While safety can never be assured, Dr Phaisit suggested that consumers consult their doctor before giving any of them a try.

"Ideally, consumers should opt for supplements that have at least eight to 10 clinical researches to back them up," said the nutrition specialist. "Some brands put their products on the market even though they have been tested only on rats. Take raspberry ketone, for instance. It is widely available despite never having been tested on humans.

"The point is, the internet does not reliably say if this or that product can be trusted. But at the same time, this does not mean supplements available online are all based on lies. So it's best to talk to your doctor about what's appropriate and read product labels carefully. After all, weight-control medication should be used only by those who really need it."

Natcha is of the same viewpoint. Today she enjoys a dish of kha moo. She no longer relies on fat-blocker pills, which, in her opinion, should be used only for people medically diagnosed as overweight.

"A lot of Thai women think they are too fat and want to lose weight. This is funny," she said. "They forget that when it comes to weight control, regular exercise and proper diet choices are more important than any medicine or supplement. If you want to eat kha moo, go exercise. There's no such thing as a quick fix."


* Not her real name.

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