Orlistat for Weight Loss: Is It Still Worth Taking?

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Are you considering orlistat for weight loss? Unlike many newer weight loss medications that influence appetite, hunger signals, or feelings of fullness, orlistat works directly inside your digestive tract to reduce the amount of fat your body absorbs from food. It has been used for decades and remains an option for people who want medication-assisted weight management without taking a stimulant or an appetite-suppressing drug.

However, orlistat is not a magic weight loss pill. Its effects are generally modest, it works best alongside a calorie-controlled diet, and its most recognizable side effects involve the digestive system. Some people find it helpful, while others find the oily stools, urgency, and dietary restrictions difficult to tolerate. Understanding how the medication works, how to take it correctly, and what its limitations are can help you decide whether it is an appropriate option.

This guide covers how orlistat works, its different brand names and doses, how to use it properly, what kind of weight loss to expect, potential side effects, important drug interactions, dietary recommendations, and how it compares with other weight loss treatments. The goal is to explain both the benefits and the drawbacks objectively so that you can have a more informed conversation with your healthcare professional.

What Is Orlistat?

Orlistat is a medication used to help manage overweight and obesity. It belongs to a class of drugs called gastrointestinal lipase inhibitors. These medications interfere with the enzymes that digest fat in the gastrointestinal tract, allowing some of the fat from a meal to pass through the intestines without being absorbed.

Unlike stimulant-based medications, orlistat does not work by increasing your heart rate or directly suppressing your appetite. Unlike medications that act on hormones involved in hunger and fullness, it does not directly change those signals either. Instead, it reduces the number of calories your body obtains from dietary fat.

Because relatively little of the medication enters the bloodstream, its main effects occur inside the digestive system. This is an advantage for some people, but it does not mean that orlistat is completely risk-free. It can interfere with the absorption of important nutrients and certain medications, and rare but serious complications have been reported.

Who Is Orlistat Intended For?

Orlistat is generally intended for adults who have obesity or who are overweight and have additional weight-related health risks. The precise eligibility criteria depend on the product, country, and clinical guideline being followed. For example, some prescribing recommendations consider medication for people with a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher when conditions such as high blood pressure or type 2 diabetes are present.

BMI is calculated using a person’s weight and height. Although it is commonly used to assess eligibility for weight management treatment, it is not a complete measure of health. Waist circumference, weight-related medical conditions, previous weight loss attempts, medications, eating habits, and personal circumstances may also influence whether treatment is appropriate.

Orlistat is not intended to replace healthy eating, physical activity, sleep, or other appropriate medical care. It is also not generally a suitable choice for someone seeking to lose just a few pounds for cosmetic reasons. A healthcare professional can help determine whether medication is warranted and whether another treatment would offer greater benefits.

Orlistat Brand Names: Xenical, Alli, Orlos, Orlica, and More

Orlistat is sold under several brand names, and the products available depend on the country. The best-known names include Xenical, Alli, Orlos, Beacita, and Orlica. Other countries have additional locally marketed products, while some pharmacies sell the medication under its generic name, orlistat.

The following are examples of brand names associated with orlistat in different markets. This is a broad reference list rather than a guarantee that every product is currently available, approved, or actively marketed in every country.

Xenical: A well-established prescription brand, generally containing 120 mg of orlistat per capsule.
Alli: A lower-dose 60 mg product marketed as an over-the-counter weight loss aid in the United States and in certain other markets. Its availability and regulatory status vary by country.
Orlos: A 60 mg orlistat brand marketed in the United Kingdom.
Beacita: A brand marketed in some European countries.
Orlica: A 120 mg orlistat product reported in the Indian market.
Other regional names: Depending on the country, names have included Lipiblock, Lipoclin, Lipoxen, Lystate, Orlax, Orlipid, Orlistate, Siluestat, Xenilipi, Adelex, Disgrasil, Obestat, Orlifit, Orliplus, Orlisbelt, Orlivet, Aslene, Cuvarlix, Odistad, Zerocal, Zerotex, Thincal, Xenabi, Elimens, Linestat, Normofit, Normostat, Orlidunn, Orliloss, Obelit, and Reeshape.

Brand names, manufacturers, strengths, and regulatory approvals can change over time. A product advertised under one of these names in another country should not automatically be assumed to be approved or available where you live. Purchase orlistat through a legitimate pharmacy and verify the active ingredient, strength, and product registration rather than relying on the brand name alone.

In Canada, Xenical 120 mg has been listed as a prescription product. Availability in other countries may differ, particularly for lower-dose products. A local pharmacist can clarify which formulations are authorized and appropriate for you.

How Does Orlistat Work?

Orlistat works by interfering with enzymes called lipases. These enzymes normally break down dietary fat into smaller components that can be absorbed through the intestinal wall and used or stored by the body.

When you eat a meal containing fat, enzymes produced in the digestive tract help break that fat down so it can be absorbed. Orlistat inhibits some of this enzyme activity, particularly that of gastric and pancreatic lipases. As a result, a portion of the fat remains undigested and passes out of the body in your stool.

At the standard prescription dose of 120 mg three times daily, orlistat can prevent the absorption of approximately 25% to 30% of the fat in a meal under typical study conditions. The exact proportion depends on factors such as the dose, meal composition, and individual response. It does not block all dietary fat, and it does not prevent the absorption of all calories.

For example, if a meal contains 30 grams of fat, some of that fat may pass through the digestive tract instead of being absorbed. However, the amount that escapes absorption is not a fixed percentage for every meal or every person.

The medication does not directly block the absorption of carbohydrates or protein in the same way. Calories from foods such as bread, rice, sugar, juice, and other carbohydrate sources can still be absorbed normally, as can calories from protein. This is one reason why eating fewer calories overall remains important while taking orlistat.

Is Orlistat a Fat Burner?

Not in the way the term is often used in supplement advertising. Orlistat does not directly stimulate the breakdown of stored body fat, increase metabolism substantially, or cause your body to burn fat simply because you have swallowed a capsule. Its primary effect is to reduce the absorption of some of the fat you eat.

When fewer calories are absorbed than your body uses, your body can draw on stored energy, including body fat. That energy deficit is what supports weight loss. However, orlistat cannot guarantee a calorie deficit, because the medication does not block all the fat in your meals and does not stop you from consuming excess calories from other sources.

For this reason, taking orlistat while regularly consuming large portions, sugary drinks, desserts, or other calorie-dense foods may produce disappointing results. The medication is a tool that can support a weight management plan, not a way to cancel out the effects of an otherwise excessive diet.

Does Orlistat Work Immediately?

Orlistat can begin affecting the digestion and absorption of dietary fat within the first day or two of treatment. In studies, changes in the amount of fat appearing in stool have been observed within approximately 24 to 48 hours after starting the medication.

This does not mean that you should expect to see a significant change in body weight within a day or two. Changes in body fat develop more gradually, and short-term fluctuations on the scale are often influenced by water retention, bowel contents, sodium intake, and other factors.

How to Take Orlistat Properly

Taking the correct dose at the correct time matters. Orlistat is intended to be taken with meals containing fat, alongside a reduced-calorie, nutritionally balanced eating plan. Taking more than the recommended amount is not a reliable way to accelerate weight loss and may increase the risk of adverse effects.

1. Understand the Difference Between 60 mg and 120 mg

The two commonly encountered strengths are:

60 mg: The lower-strength formulation used by Alli in markets where it is approved for nonprescription weight loss. It is generally taken up to three times daily with meals containing fat, according to the product instructions.
120 mg: The standard prescription dose used by Xenical and other prescription orlistat products. The usual regimen is one 120 mg capsule three times daily with each main meal containing fat, subject to the prescribing instructions.

These strengths should not be treated as interchangeable instructions. Do not double the dose of a 60 mg over-the-counter product to imitate the prescription regimen, and do not take extra capsules because you believe a meal contained too much fat. Use the dose specified for your particular product or prescribed by your healthcare professional.

2. Take It With the Right Meal

For the standard 120 mg prescription formulation, the capsule is generally taken immediately before, during, or up to one hour after each main meal that contains fat. Lower-dose products have similar meal-based instructions, but you should follow the exact directions on the product you are using.

If you skip a meal or eat a meal that contains no fat, the dose can generally be omitted. There is no reason to take an extra capsule later to make up for a missed dose. Do not double the next dose.

Orlistat is not intended to be taken as a single large dose once a day. Its usual dosing schedule is distributed across the day’s main meals so that it can act on dietary fat as it enters the digestive tract.

3. Spread Fat Intake Across Your Meals

Prescription guidance commonly recommends a nutritionally balanced, reduced-calorie diet in which approximately 30% of daily calories come from fat. Rather than consuming most of your fat in a single large meal, distribute it relatively evenly across breakfast, lunch, and dinner.

For perspective, a person eating 1,800 calories per day would obtain about 540 calories from fat if fat supplied 30% of total energy. Since fat provides approximately nine calories per gram, that works out to around 60 grams of fat per day. This is an illustrative calculation, not a personal dietary prescription; your calorie requirements and appropriate fat intake may be different.

A very high-fat meal can lead to substantially more gastrointestinal side effects, including oily stools, gas with discharge, urgency, and accidental leakage. A lower-fat meal generally reduces the amount of unabsorbed fat passing through the intestines and may make treatment easier to tolerate.

4. Do Not Take More Than the Recommended Amount

Taking extra orlistat does not reliably produce extra weight loss. Prescription information indicates that doses above 120 mg three times daily have not demonstrated additional benefit. Taking more than directed can expose you to unnecessary side effects and nutritional complications.

If you believe the medication is not working, review your calorie intake, adherence, meal composition, and other factors with your healthcare professional rather than increasing the dose on your own.

What Kind of Weight Loss Can You Expect?

Orlistat can help people lose weight, but its average benefit is relatively modest compared with some newer weight management medications. It is important to distinguish between the total weight lost by people taking orlistat and the additional weight loss attributable to the medication itself.

In pooled one-year clinical trial data for prescription orlistat, participants assigned to orlistat lost an average of approximately 13.4 pounds, while participants assigned to placebo lost around 5.8 pounds. Both groups received dietary advice and followed a calorie-reduced eating plan. The average difference between groups was approximately 3 percentage points of initial body weight.

These results show that orlistat can add to the effects of diet and lifestyle changes, but it does not account for all the weight lost by people taking it. People in the placebo groups also lost weight, largely because they were following a reduced-calorie program and receiving support.

Individual results vary. Some people lose substantially more than the average, while others lose very little or stop treatment because of side effects. The degree of weight loss depends on factors such as starting weight, eating habits, adherence, physical activity, medical conditions, and the medication’s tolerability.

It would be misleading to promise that everyone can lose 3% to 5% of their body weight within a few weeks. Meaningful weight loss usually develops over time, and early changes on the scale may include water loss rather than body fat alone.

How Many People Lose at Least 5% of Their Body Weight?

In pooled clinical trials, 57% of participants who completed one year of treatment with prescription orlistat lost at least 5% of their initial body weight, compared with 31% of participants who completed treatment in the placebo group. These percentages describe people who completed the trial rather than everyone originally enrolled, so they should not be interpreted as a guarantee of success for a new user.

A 5% weight reduction can still be clinically useful for some people. For example, someone who initially weighs 200 pounds would reach a 5% reduction after losing 10 pounds. The potential health benefits depend on individual circumstances, but modest weight loss can improve some weight-related risk factors, including blood pressure, blood sugar, and blood lipid levels.

When Should You Know Whether Orlistat Is Working?

Weight should be monitored over time rather than judged by daily fluctuations. Your healthcare professional may review your progress after the first several weeks and again around three months to determine whether continued treatment is worthwhile.

Some clinical guidelines use a loss of approximately 5% of initial body weight after 12 weeks as a threshold for reassessing or discontinuing orlistat. The precise recommendation depends on the applicable guideline, the formulation, and the individual circumstances. Follow the stopping instructions given by your prescriber rather than applying a universal threshold without medical advice.

If you have followed the treatment plan consistently but have made little progress, your healthcare professional can help identify possible reasons. These may include unnoticed calorie intake, difficulty tolerating the medication, other medicines that influence weight, or a medical condition that warrants attention. Another weight management approach may be more suitable.

What Happens When You Stop Taking Orlistat?

The effect of orlistat on fat absorption wears off quickly after discontinuation. Measurements of fat in stool generally return toward pretreatment levels within approximately two to three days. The medication does not permanently alter your ability to absorb dietary fat or automatically prevent future weight gain.

Some people regain weight after stopping treatment, especially if the habits that contributed to their previous weight gain return. This is not unique to orlistat. Obesity is a chronic condition for many people, and long-term weight management may require continuing lifestyle support or another form of treatment.

Discuss the expected duration of treatment with your healthcare professional. The decision to continue, stop, or switch medications should take account of weight loss, side effects, nutritional status, and any changes in your health.

What About Orlistat Side Effects?

The most distinctive side effects of orlistat are gastrointestinal. This makes sense when you consider its mechanism: some of the fat that would normally be digested and absorbed remains in the intestinal contents and is eventually passed in the stool.

People taking orlistat commonly describe oily stools, oil spotting, gas accompanied by discharge, sudden urges to use the toilet, and difficulty controlling bowel movements. Some experience bloating, abdominal discomfort, or more frequent bowel movements than usual.

These effects are often most troublesome when treatment begins and may improve as someone learns to manage the fat content of meals. However, they do not disappear for everyone, and persistent or severe symptoms can make the medication impractical to use.

In clinical trials, gastrointestinal effects were considerably more common with orlistat than with placebo. Their frequency varies between studies and products, and the figures below should be viewed as approximate examples rather than precise predictions of your individual risk.

Common Gastrointestinal Side Effects

Oily spotting: Greasy material may leak from the rectum and leave stains on underwear.
Flatulence with discharge: Passing gas may be accompanied by oily material, which can be unpleasant and difficult to anticipate.
Fatty or oily stools: Stools may appear greasy, unusually loose, or difficult to flush.
Increased bowel movements: Some people need to use the toilet more often than usual.
Urgency: The urge to have a bowel movement may develop suddenly, leaving little time to reach a toilet.
Fecal leakage or incontinence: A minority of users may have difficulty controlling their bowel movements, particularly when gastrointestinal effects are pronounced.
Abdominal discomfort: Cramping, bloating, or abdominal pain may occur.

In prescription clinical trials, oily spotting was reported in approximately one-quarter of orlistat-treated participants during the first year, with flatulence accompanied by discharge and fecal urgency also occurring frequently. The exact rates depend on the study and are generally lower with placebo.

Some people also report headache, fatigue, or other symptoms during treatment. Not every symptom reported in a clinical trial is necessarily caused by the medication, and new or persistent symptoms should not automatically be attributed to orlistat without considering other explanations.

Why Does Orlistat Cause Oily Stools?

Oily stools are a direct consequence of the medication’s intended action. Normally, much of the fat in your meal is digested and absorbed before the remaining waste reaches the colon. Orlistat prevents some of that fat from being absorbed, so more fat remains in the intestinal contents and is excreted.

The problem becomes more noticeable when a meal contains a large amount of fat. For example, a meal consisting of fried food, creamy sauces, fatty meats, and a rich dessert may leave substantially more unabsorbed fat in the gut than a more moderate meal.

Some stools may look yellowish or orange, but this is not a reliable measure of how much weight you are losing or how effectively the medication is working. The more important issue is the presence of oily material, stool changes, or urgency that interfere with daily life.

Can You Reduce the Side Effects?

The most effective practical measure is to follow the recommended reduced-calorie diet and keep fat intake moderate and reasonably evenly distributed among meals. This does not mean eliminating all fat. It means avoiding meals that contain a disproportionately large amount of fat.

Limit deep-fried foods, very fatty meats, rich cream sauces, and meals containing several high-fat components at once.
Choose a balanced combination of vegetables, fruit, whole grains, lean protein sources, and moderate portions of healthy fats.
Spread your daily fat intake across meals rather than saving most of it for dinner.
Take the medicine only as directed and omit the dose when the instructions say to do so, such as when a meal is skipped or contains no fat.
Pay attention to how particular meals affect your symptoms, and discuss persistent diarrhea, pain, or difficulty controlling bowel movements with your healthcare professional.

Do not deliberately consume large amounts of fat to make orlistat seem more effective. That approach can cause more side effects without providing a sensible weight management strategy. Likewise, severe or persistent gastrointestinal symptoms should not simply be accepted as the price of losing weight.

Serious but Rare Side Effects

Most adverse effects associated with orlistat involve the digestive tract, but rarer problems deserve particular attention. Although these complications are uncommon, they can be serious and may require the medication to be stopped and medical assessment to be arranged.

Kidney Stones and Kidney Injury

Orlistat has been associated with rare cases of kidney stones and kidney injury, including a condition called oxalate nephropathy. Oxalate is a substance that can be absorbed from the digestive tract and eliminated through the kidneys. Changes in intestinal fat digestion may increase oxalate absorption in some people, potentially contributing to calcium oxalate deposits in the kidneys.

In June 2026, the United States Food and Drug Administration announced updated labeling for Alli to highlight the risk of acute kidney injury and kidney stones. These kidney-related concerns also appear in prescribing information for prescription orlistat products. People with existing kidney disease, a history of kidney stones, or other relevant risk factors should discuss the risks with a healthcare professional before taking orlistat.

Seek prompt medical advice if you develop symptoms such as pain in your back or groin, painful urination, blood in the urine, swelling of the feet or legs, or a noticeable reduction in urination. Stop taking the medication and obtain urgent medical assessment if kidney injury or kidney stones are suspected.

Liver Injury

Rare cases of serious liver injury have been reported in people taking orlistat. A direct causal relationship has not been established in every reported case, but the possibility is important enough to warrant attention.

Warning signs include yellowing of the skin or eyes, dark urine, unusually pale stools, persistent itching, reduced appetite, or pain in the upper-right part of the abdomen. These symptoms can have several causes, but if they develop during treatment, stop taking orlistat and seek prompt medical evaluation.

Pancreatitis, Colitis, and Severe Abdominal Symptoms

Pancreatitis and inflammatory intestinal conditions have been reported in people using orlistat, although these events are uncommon and the degree to which the medication directly causes them may be uncertain. Severe or persistent abdominal pain should not automatically be dismissed as an ordinary digestive side effect.

Seek urgent medical attention for severe abdominal pain, especially if it is persistent or accompanied by repeated vomiting, fever, or significant tenderness. Blood in the stool, severe dehydration, or other unusual symptoms also warrant prompt assessment.

Allergic Reactions

Rarely, a person may develop a hypersensitivity reaction to orlistat or one of the inactive ingredients in a particular formulation. A rash or itching should be discussed with a healthcare professional, especially if it worsens or occurs with other symptoms.

Swelling of the face, lips, tongue, or throat, or difficulty breathing, may indicate a serious allergic reaction. These symptoms require emergency medical attention.

When Should You Stop Taking Orlistat?

Mild oily stools or increased bowel movements can occur during treatment, but there is a difference between expected gastrointestinal effects and symptoms that may indicate a serious complication.

Stop taking orlistat and seek medical advice promptly if you develop signs of kidney injury, possible liver injury, a severe allergic reaction, or other concerning symptoms. Severe abdominal pain, difficulty breathing, or markedly reduced urination warrants urgent assessment. Do not restart the medication after a suspected serious drug reaction unless your healthcare professional specifically advises that it is appropriate.

Orlistat and Vitamin Absorption

One of the most important nutritional considerations with orlistat is its effect on fat-soluble vitamins. These include vitamins A, D, E, and K, as well as beta-carotene, which the body can convert into vitamin A.

Because orlistat reduces the digestion and absorption of some dietary fat, it can also reduce the absorption of these nutrients. The effect does not mean that everyone taking the medication will develop a vitamin deficiency, but it creates a reason to pay attention to nutritional intake and to follow the recommended supplementation instructions.

Vitamin A supports vision and normal immune function. Vitamin D is important for calcium absorption, bone health, and muscle function. Vitamin E helps protect cells against oxidative damage, while vitamin K is needed for normal blood clotting and also contributes to bone health.

Inadequate vitamin intake over time can have consequences, particularly for people who already have dietary restrictions, absorb nutrients poorly, have other medical conditions, or take medications affected by vitamin levels. This is one reason that an extreme or nutritionally unbalanced weight loss diet is not an appropriate partner for orlistat.

Should You Take a Multivitamin With Orlistat?

Prescribing information generally recommends taking a daily multivitamin containing vitamins A, D, E, and K, along with beta-carotene or an appropriate vitamin A source, while using orlistat. Your healthcare professional or pharmacist can help you select a suitable product and decide whether your individual circumstances require additional monitoring.

Timing matters. Take your multivitamin at least two hours before or after orlistat. Taking it at bedtime is a practical option for many people because it separates the supplement from the usual meal-time doses.

A multivitamin does not make an otherwise poor diet nutritionally complete, and taking a larger dose than recommended is not necessarily better. Very high doses of certain vitamins can be harmful. If blood tests or your medical history suggest a specific deficiency, your clinician can recommend an appropriate supplement and dose.

Vitamin injections are not routinely required simply because you are taking orlistat. They should not be assumed to prevent all nutritional deficiencies or to accelerate fat loss. Oral supplementation is usually the starting point when supplementation is indicated, unless a clinician identifies a separate reason to use an injectable nutrient.

Who Should Avoid Orlistat or Use It With Caution?

Although orlistat is suitable for many people who need help with weight management, it is not appropriate for everyone. Certain conditions are reasons to avoid it, while others require a careful discussion of potential risks and monitoring.

Conditions in Which Orlistat Is Contraindicated

Pregnancy: Orlistat should not be used during pregnancy because intentional weight loss during pregnancy offers no expected benefit and may compromise nutritional needs.
Chronic malabsorption syndrome: People who already have persistent difficulty absorbing nutrients from food should not take orlistat.
Cholestasis: This condition interferes with the normal flow of bile from the liver. It is a contraindication to orlistat.
Known hypersensitivity: Anyone with a known serious allergy to orlistat or an ingredient in the particular product should not use it.

Breastfeeding is also a reason to avoid orlistat under applicable product guidance. The extent to which the drug passes into human milk is not established, and its potential effects on maternal nutrient absorption are another concern. Anyone who is pregnant, breastfeeding, planning pregnancy, or who becomes pregnant during treatment should consult their healthcare professional rather than continuing the medication independently.

Conditions That Require Extra Caution

Before starting treatment, tell your healthcare professional if you have kidney disease, a history of kidney stones, digestive or rectal problems, gallbladder disease, diabetes, thyroid disease, or any condition that affects nutrient absorption. Your full medication list is also important because some interactions require dose separation or additional monitoring.

Orlistat may be inappropriate for some people with eating disorders or those who are already following a severely restrictive diet. Weight loss medications should be used within a medically appropriate plan rather than as a way to compensate for excessive eating, sustain starvation-level intake, or intensify unhealthy weight control behaviours.

Is Orlistat Safe During Pregnancy or Breastfeeding?

Orlistat should not be used for weight loss during pregnancy. Available information about exposure during pregnancy is limited, and although available evidence has not established an increased risk of birth defects, that does not make intentional weight loss with orlistat appropriate during pregnancy.

If you become pregnant while taking orlistat, stop the medication and contact your healthcare professional. People planning to become pregnant should discuss their weight management options and the appropriate timing for discontinuing treatment before trying to conceive.

During breastfeeding, the medicine is generally avoided because its presence in human milk has not been adequately established and because interference with the absorption of certain nutrients is undesirable during this period. A clinician can help identify a suitable approach to weight management after pregnancy.

Important Drug Interactions With Orlistat

Orlistat can interfere with the absorption or effectiveness of certain medications. Some interactions occur because the medication affects nutrient absorption, while others involve changes in how much of another drug reaches the bloodstream. The risk may depend on the medication, its dose, and the condition being treated.

Always provide your doctor and pharmacist with a complete list of prescription medications, over-the-counter products, vitamins, minerals, and supplements before starting treatment. Do not stop or change another prescribed medication on your own to accommodate orlistat.

Cyclosporine

Orlistat can reduce the absorption of cyclosporine, an immunosuppressant used in certain transplant recipients and people with immune-related conditions. Lower cyclosporine concentrations may reduce its effectiveness. If both medications are used, specific timing and close monitoring are required; prescribing guidance generally recommends separating their administration by at least three hours.

Levothyroxine and Thyroid Medication

Levothyroxine is used to treat hypothyroidism. Orlistat may reduce its absorption and interfere with thyroid control. The medications should generally be separated by at least four hours, and thyroid function may need to be monitored after treatment begins or changes.

Warfarin and Other Anticoagulants

Warfarin is an anticoagulant that requires careful monitoring. Because orlistat can reduce the absorption of vitamin K, it may alter the response to warfarin and affect blood clotting measurements, including the INR. People taking warfarin should inform their prescribing clinician before starting orlistat and may require additional monitoring.

Amiodarone

Orlistat may reduce exposure to amiodarone, a medication used to treat certain heart rhythm disorders. This could potentially reduce the effectiveness of treatment. People taking amiodarone should not start orlistat without medical review.

Antiepileptic Medications

Orlistat may alter the absorption of some antiepileptic drugs. Changes in drug exposure can be particularly concerning for people whose seizures are controlled by stable medication doses. Anyone taking an antiseizure medication should discuss the potential interaction with their prescriber and report any change in seizure frequency or severity.

HIV and Other Antiretroviral Medications

Interactions between orlistat and certain antiretroviral medications have been reported, including concerns about reduced antiviral exposure and loss of virological control in some patients. People receiving treatment for HIV should seek advice from their specialist before using orlistat.

Diabetes Medications

Weight loss can improve blood sugar control in some people with diabetes. As weight and glucose levels change, the doses of insulin or other glucose-lowering medications may need to be adjusted. Orlistat is not a replacement for diabetes treatment, and people taking these medications should monitor their blood sugar as directed by their healthcare team.

Oral Contraceptives

Orlistat does not ordinarily act as a hormonal contraceptive interaction, but severe diarrhea can interfere with the reliable absorption of an oral contraceptive pill. If severe diarrhea occurs, follow the instructions for your contraceptive product and use additional barrier contraception when recommended. If you are unsure whether protection has been affected, contact a pharmacist or healthcare professional promptly.

These examples are not a complete list of possible interactions. Even medications that are not mentioned here may require consideration, so a pharmacist or prescribing clinician should review your complete medication list before treatment begins.

Orlistat Diet Guide

Diet is a major factor in determining whether orlistat is both useful and tolerable. The medication reduces the absorption of some fat, but it does not reduce the absorption of all calories or automatically guarantee that you will lose weight. The aim is to combine the medication with a sustainable calorie deficit and a balanced diet that meets your nutritional needs.

One common misconception is that orlistat must be combined with a particular low-carbohydrate diet to work. That is not true. A low-carbohydrate diet may suit some people, but it is not a requirement for orlistat to have an effect. The medication works on dietary fat, regardless of whether the rest of the diet contains more carbohydrates or more protein.

Likewise, it is incorrect to assume that a high-carbohydrate diet cannot support weight loss while taking orlistat. Carbohydrates are absorbed normally, so portion sizes and total calorie intake remain important. Someone can lose weight while eating carbohydrates, provided their overall eating pattern supports a sustainable calorie deficit.

On the other hand, an extremely high-fat diet can make orlistat unpleasant to take because more unabsorbed fat remains in the intestines. A diet that eliminates virtually all fat is not a desirable long-term solution either, because dietary fat provides essential fatty acids and helps support normal nutrient absorption and overall nutritional adequacy.

What Kind of Diet Works Well With Orlistat?

Rather than relying on one rigid diet, focus on a balanced eating pattern that keeps calories appropriate for your needs, avoids excessively fatty meals, and provides sufficient protein, fiber, vitamins, minerals, and essential fatty acids. Several approaches can be compatible with orlistat when they are designed appropriately.

Low Carbohydrate Diets
Higher-Protein Diets
Dietary Patterns Rich in Soluble Fiber

For example, a calorie-controlled, relatively low-carbohydrate Mediterranean diet or a well-planned vegetarian diet that includes suitable protein sources can complement orlistat. These are examples rather than special combinations that have been proven to outperform all other diets when used with the medication.

The most important consideration is whether you can follow the diet consistently while meeting your nutritional needs. A dietary plan that is too restrictive, too complicated, or poorly suited to your preferences is less likely to be sustainable.

Should You Follow a Low-Fat Diet?

Yes. A reduced-fat diet is a core component of using orlistat appropriately, but this does not mean that you should eliminate all fats from your meals. Prescription guidance commonly recommends approximately 30% of total daily calories from fat, with fat distributed across the main meals.

It is useful to distinguish between foods that contain small or moderate amounts of fat and meals that concentrate large amounts of fat into a single sitting. A meal containing a modest portion of olive oil, nuts, fish, or another nutritious fat source may fit comfortably into a balanced diet. A meal dominated by fried foods, butter, cream, fatty meat, and rich desserts may be much more likely to trigger unpleasant symptoms.

Some fat is important because the body needs essential fatty acids and because many nutritious foods contain fat-soluble vitamins. However, you do not need to deliberately eat a fatty meal to make the medication work. If a meal contains no fat, the corresponding dose can generally be skipped according to the product’s instructions.

Does a Low-Carbohydrate Diet Make Orlistat More Effective?

Not necessarily. Lower-carbohydrate diets can help some individuals manage hunger or reduce their overall calorie intake, but orlistat does not directly block carbohydrate absorption. A low-carbohydrate diet is therefore a preference-based option rather than a required part of treatment.

Someone who prefers whole grains, fruit, legumes, and other carbohydrate-containing foods can still lose weight while taking orlistat. Conversely, someone following a low-carbohydrate diet can still consume too many calories, particularly if their meals contain large quantities of oils, cheese, cream, processed meats, and other energy-dense foods.

The key is to find a dietary pattern that helps you maintain an appropriate calorie intake, control hunger, obtain adequate nutrients, and avoid excessive fat in individual meals.

Why Protein and Fiber Can Be Helpful

Protein supports the maintenance of lean body tissue during weight loss and may help with fullness. Appropriate sources include fish, poultry, eggs, dairy foods, tofu, beans, lentils, and other protein-rich foods that fit your dietary preferences.

Fiber-rich foods such as vegetables, fruit, beans, oats, and whole grains can also contribute to fullness and help support normal bowel function. However, orlistat can change stool consistency, so individuals may need to adjust their food choices gradually according to their symptoms and tolerance.

There is no need to purchase a special high-protein or fiber supplement solely because you are taking orlistat. A well-planned diet may provide what you need, while supplements should be considered according to individual nutritional requirements and potential interactions.

An Example of a Practical Eating Pattern

A practical day of eating might include oatmeal with fruit and a moderate portion of nuts for breakfast; a salad or grain bowl with chicken, tofu, fish, or legumes for lunch; and a balanced dinner containing vegetables, a suitable protein source, and a moderate portion of potatoes, rice, whole grains, or another preferred carbohydrate. Meals can include modest amounts of nutritious fats without being dominated by them.

The objective is not to follow this exact menu, nor is there a universal meal plan that suits everyone. The appropriate portion sizes depend on your energy requirements, activity level, health status, and dietary preferences. A registered dietitian can help create a plan that works with orlistat while keeping nutrient intake adequate.

Orlistat Compared With Other Weight Loss Medications

Orlistat is one of several medications used for weight management. Some medications reduce fat absorption, while others influence appetite, fullness, or the hormonal signals involved in eating. These differences affect how they are taken, the types of side effects they produce, and the amount of weight loss they may support.

Orlistat vs Ozempic and Other GLP-1 Medications

Orlistat is often less effective for average weight loss than newer incretin-based treatments studied for obesity, although the exact comparison depends on the dose, population, duration of treatment, and individual response. The mechanisms are quite different. Orlistat reduces the absorption of some dietary fat, while GLP-1 receptor agonists influence appetite and fullness and can help people reduce their food intake.

Semaglutide is the active ingredient in Ozempic and Wegovy, although their approved uses, formulations, and dosing differ by country. Ozempic is primarily marketed for type 2 diabetes in many jurisdictions, whereas Wegovy is a semaglutide formulation specifically authorized for chronic weight management in relevant markets. Other medications, including tirzepatide, also have important roles in modern obesity treatment, depending on local approvals and patient suitability.

For further comparisons of medications that may be used for weight loss, see Ozempic vs Rybelsus vs Saxenda vs Victoza.

More potent average weight loss does not automatically mean that a particular medication is the best option for everyone. Different drugs have different contraindications, adverse effects, costs, administration requirements, and effects on other health conditions. The results of separate clinical trials should also not be treated as a direct head-to-head comparison unless the treatments were studied against each other in the same trial.

Orlistat vs Phentermine

Phentermine is a stimulant-type medication that acts on the central nervous system to help reduce appetite. Orlistat, by contrast, acts mainly in the digestive tract and does not function as a central appetite suppressant.

These differences mean that the drugs tend to have different practical advantages and drawbacks. Phentermine may cause insomnia, increased heart rate, or other stimulant-related effects and is subject to prescribing restrictions that vary by country. Orlistat is not a stimulant, but its digestive side effects and interactions with nutrients and medications can be major limitations.

For more information about phentermine, see What to Expect With Phentermine Weight Loss Medications.

Is Orlistat Safer Than Other Weight Loss Drugs?

Orlistat has a different safety profile from stimulant medications and treatments that act on appetite-related hormones. Its limited systemic absorption helps explain why its most characteristic adverse effects occur in the digestive tract. However, limited absorption into the bloodstream does not make the drug harmless.

Orlistat can cause substantial gastrointestinal discomfort, interfere with vitamin absorption, interact with important medications, and rarely be associated with serious complications involving the kidneys or liver. Other weight loss medications have their own risks, and the safest choice depends on a person’s medical history, current medications, and treatment goals.

Rather than asking which medication is universally safest, it is more useful to ask which option offers a reasonable balance of expected benefits, risks, convenience, and long-term sustainability for a particular individual.

Is Orlistat Still Worth Taking in the Era of GLP-1 Weight Loss Drugs?

With the arrival of newer weight loss medications such as semaglutide (Wegovy) and tirzepatide (Zepbound), it is reasonable to ask whether orlistat is still worth taking. These newer medications have changed the treatment of obesity because they can produce substantially greater average weight loss than many older medications. For some people, this makes them more attractive options. However, orlistat has not become completely obsolete, and there are still situations in which it may be worth considering.

To understand why, it helps to recognize that these medications work in very different ways. Orlistat reduces the absorption of some of the fat you eat, whereas semaglutide acts on the GLP-1 receptor to influence appetite, fullness, and eating behaviour. Tirzepatide acts on both the GIP and GLP-1 receptors, influencing several of the hormonal signals involved in appetite and metabolic regulation. These newer treatments can make it easier for some people to consume fewer calories because they feel less hungry or become satisfied with smaller meals.

How Much More Effective Are GLP-1 and Related Medications?

The difference in average weight loss can be substantial. In a large systematic review and network meta-analysis published in 2026, researchers compared evidence from hundreds of randomized trials involving medications for overweight and obesity. At approximately one year, the estimated additional weight reduction compared with lifestyle modification alone was about 9.8 percentage points for injectable semaglutide and 14.9 percentage points for tirzepatide. In the same analysis, orlistat did not show a convincing additional reduction in body weight compared with lifestyle modification alone.

These figures are averages from a statistical analysis of different trials, not a direct head-to-head comparison between every medication. They are also not promises about how much an individual will lose. Nevertheless, the broader evidence suggests that semaglutide and tirzepatide generally offer a greater average weight loss effect than orlistat. This is an important consideration for someone who needs to lose a substantial amount of weight or who has not achieved meaningful progress with older treatments.

However, weight loss is not the only consideration. A medication’s suitability also depends on its side effects, contraindications, costs, availability, administration requirements, effects on other medical conditions, and whether the person can continue using it as part of a long-term treatment plan.

What Advantages Does Orlistat Still Offer?

Although orlistat generally produces less weight loss than newer incretin-based medications, it has several characteristics that may appeal to particular individuals.

It is an oral medication. Orlistat is taken as a capsule with meals rather than administered by injection. Some people prefer a pill-based treatment or wish to avoid injections. Availability of oral alternatives among newer weight loss medications varies by country and approved indication.
It works locally in the digestive tract. Orlistat has relatively little systemic absorption and does not directly stimulate the central nervous system or act on appetite-related hormone receptors. This gives it a different side effect profile from many other weight loss medications, although it does not make orlistat risk-free.
It may be more accessible in some circumstances. Depending on the country, a generic formulation may be available at a lower price than certain newer treatments. Prescription requirements, insurance coverage, pharmacy prices, and individual out-of-pocket costs vary, however, so orlistat is not necessarily cheaper for everyone.
It may suit someone who wants a modest additional effect. A person who is comfortable with a calorie-controlled diet, already keeps dietary fat moderate, and is satisfied with a more modest weight loss goal may find orlistat reasonable, provided they are an appropriate candidate and tolerate it well.
It remains an established treatment option. Orlistat is still included among the medications recommended for selected adults with obesity in clinical practice guidance. Its continued role is not based on producing the largest possible weight loss, but on offering another option that may fit an individual’s circumstances.

These advantages are not universal. Orlistat’s meal-related dosing, oily stools, bowel urgency, possible reduction in fat-soluble vitamin absorption, and interactions with certain medications can make it difficult to use. People with particular kidney or gastrointestinal problems may also need to avoid it. A treatment that is inexpensive or convenient on paper is not a good value if the person cannot tolerate it or obtains little benefit.

What Are the Advantages and Disadvantages of Newer Weight Loss Drugs?

Semaglutide and tirzepatide are often more compelling choices for people who need greater weight loss, particularly when excess weight is contributing to conditions such as type 2 diabetes or other weight-related health problems. Depending on the specific medication and the person taking it, these treatments can also improve certain metabolic risk factors. Semaglutide has additionally demonstrated cardiovascular benefits in particular eligible patient populations.

However, these medications are not suitable for everyone. Common adverse effects include nausea, vomiting, diarrhea, constipation, and other digestive symptoms, particularly during dose escalation. More serious problems, including gallbladder complications and pancreatitis, are also considerations. The specific warnings, contraindications, and monitoring requirements differ between medications, so a healthcare professional must assess whether a particular treatment is appropriate.

Cost and access can also be major barriers. Some people cannot afford these medications without insurance coverage, while others cannot use them because of medical contraindications, previous adverse effects, or other individual considerations. Although oral formulations and additional treatment options are expanding in some markets, not every formulation is approved or available everywhere.

Another important consideration is what happens after treatment stops. Obesity frequently requires long-term management, and weight regain can occur after discontinuing semaglutide or tirzepatide. These medications should therefore be considered as part of a longer-term care plan rather than a short course that permanently resolves weight management difficulties. Orlistat does not provide a permanent effect after discontinuation either.

Should You Try Orlistat Before a GLP-1 Medication?

There is no universal rule that a person must try orlistat before being prescribed semaglutide or tirzepatide. The appropriate treatment depends on factors such as the amount of weight loss needed, weight-related health conditions, previous treatment attempts, contraindications, tolerability, cost, and local prescribing criteria.

For someone who is eligible for medication and whose main goal is substantial weight loss, discussing semaglutide or tirzepatide with a healthcare professional may be worthwhile because their average results are generally greater. This does not mean that everyone needs the most potent available medication. A more modest treatment may be reasonable when it aligns with the person’s goals and circumstances, particularly if the expected benefit is meaningful to them.

If orlistat has already helped you lose weight and you tolerate it well, there may be no reason to abandon it solely because newer drugs exist. On the other hand, if you have taken it consistently, followed the recommended diet, and achieved little meaningful progress, it is worth reviewing whether another treatment would be more appropriate rather than continuing indefinitely without benefit.

Can You Take Orlistat Together With a GLP-1 Medication?

Combining weight loss medications may seem like a way to obtain the benefits of both treatments, but doing so should not be assumed to produce better results or to be safe simply because the drugs work differently. There is limited high-quality evidence to establish the additional benefits and safety of routinely combining orlistat with newer incretin-based medications for weight management.

Both approaches can cause gastrointestinal symptoms, potentially making a combination more difficult to tolerate. Orlistat also has its own nutritional considerations and drug interactions. Do not add orlistat to semaglutide, tirzepatide, or another weight loss medication without discussing the combination with your prescribing clinician.

The Bottom Line: Is Orlistat Still Worth It?

Orlistat can still be worth considering, but it is no longer the most effective option for many people seeking substantial medication-assisted weight loss. Newer treatments such as semaglutide and tirzepatide generally produce greater average reductions in body weight, although they bring their own side effects, costs, access limitations, and long-term treatment considerations.

Orlistat may remain a reasonable choice for an appropriate person who prefers an oral medication, cannot use or access a newer treatment, or values a more modest effect and can comfortably follow the dietary recommendations. It is less attractive when the individual needs substantial weight loss, experiences persistent bowel-related side effects, or has achieved little benefit despite using it correctly.

The most useful question is not simply which drug is newest or strongest, but which treatment offers the best balance of effectiveness, safety, affordability, and sustainability for you. A healthcare professional can help compare the available options, establish realistic goals, and determine when it makes sense to continue, change, or discontinue treatment.

FAQ

How Effective Is Orlistat?

Orlistat can support weight loss when combined with a calorie-controlled diet and other appropriate lifestyle changes. In pooled one-year trials of prescription orlistat, the medication group lost an average of about 13.4 pounds, compared with about 5.8 pounds in the placebo group. Both groups received dietary advice, and the average additional weight reduction associated with orlistat was approximately 3 percentage points of initial body weight.

The results vary considerably between individuals. Some people lose a clinically meaningful amount of weight, while others experience only modest changes or discontinue the medication because of side effects. It would be misleading to promise a particular number of pounds lost within a few weeks.

Diet remains important throughout treatment. Eating more calories than your body uses can limit weight loss even when some fat absorption is blocked. Conversely, a consistent calorie deficit and supportive lifestyle changes can contribute to weight loss even without orlistat.

Xenical vs Alli vs Orlica: Which Is Better?

Xenical, Alli, and Orlica are names associated with orlistat products, but the products are not necessarily available in the same countries or at the same strengths.

Xenical is commonly associated with the prescription 120 mg formulation. Alli is a well-known 60 mg product sold over the counter in certain markets, particularly the United States. Orlica has been reported as a 120 mg product in India. The exact product, manufacturer, current approval, and local availability should be verified rather than inferred from the brand name.

Higher-strength prescription orlistat is not automatically the right choice for every person. A lower-strength product may be appropriate for some eligible adults where it is approved, while others may be better served by a different treatment. Both dose and suitability depend on the applicable product instructions and individual circumstances.

Do not take extra Alli capsules in an attempt to recreate the prescription Xenical dose. Follow the instructions for the specific product you use, and ask a pharmacist or prescriber about appropriate alternatives if the medication is not meeting your needs.

Does Orlistat Work Better With a Low-Carb Diet?

Not necessarily. Orlistat reduces the absorption of some dietary fat; it does not directly block carbohydrate absorption. A low-carbohydrate diet can help some people reduce calorie intake, but other balanced dietary patterns can also support successful weight loss.

The most important dietary factors are maintaining an appropriate calorie intake, keeping fat consumption moderate and distributed across meals, eating enough protein and fiber, and obtaining adequate vitamins and minerals. The diet should also be sustainable enough to follow over the long term.

Can I Eat Fat While Taking Orlistat?

Yes. You do not need to eliminate fat completely, and a nutritionally balanced diet should contain appropriate sources of dietary fat. However, meals that are excessively high in fat can increase gastrointestinal side effects and make treatment much harder to tolerate.

The usual prescription dietary recommendation is for approximately 30% of daily calories to come from fat, with intake distributed across the main meals. Follow your individual dietary guidance and avoid treating the medication as permission to eat unlimited amounts of fatty foods.

What Happens If I Forget a Dose?

If you forget a dose, follow the instructions for your particular product. For the standard prescription regimen, the dose can generally be taken during the meal or within one hour afterward. If more than an hour has passed, skip the missed dose and return to your usual schedule with the next appropriate meal.

If you skip a meal or eat a meal containing no fat, the corresponding dose can generally be omitted. Never double your next dose or take extra capsules to compensate for a missed one.

Why Am I Not Losing Weight With Orlistat?

There are several possible reasons. The most common practical explanation is that blocking the absorption of some dietary fat does not guarantee an overall calorie deficit. Calories from carbohydrates, protein, beverages, snacks, and the fat that is still absorbed can all contribute to your total intake.

Other possibilities include inconsistent use, difficulty following the dietary recommendations, medication side effects that interfere with adherence, other medications that promote weight gain, or underlying medical conditions. Weight changes can also be obscured temporarily by fluid retention and other normal fluctuations.

If your weight has not changed meaningfully after a reasonable trial, speak with your healthcare professional. They can review your progress, assess whether the medication remains appropriate, and help determine whether another treatment or additional support would be more effective.

Can Orlistat Cause Vitamin Deficiencies?

Yes, orlistat can reduce the absorption of fat-soluble vitamins A, D, E, and K, as well as beta-carotene. The risk varies by person and depends on factors such as diet, treatment duration, baseline nutritional status, and other medical conditions.

A daily multivitamin containing the relevant fat-soluble vitamins is generally recommended, taken at least two hours before or after orlistat. This reduces the likelihood that the medication will interfere with absorption of the supplement. A healthcare professional can advise whether additional supplementation or monitoring is needed.

Can I Take Vitamin Injections to Prevent Deficiencies or Boost Fat Burning?

Vitamin injections are not routinely needed for people taking orlistat, and there is no sound basis for assuming that injectable vitamins will increase fat burning in someone who does not have a relevant deficiency. Injections may be appropriate for specific medical indications, but they are not a substitute for a balanced diet and the recommended multivitamin guidance for orlistat.

For more background on Vitamin Injection Therapies, it is important to distinguish claims about general wellness or fat burning from established medical uses. A clinician should determine whether injections are necessary based on the individual rather than using them routinely to offset possible nutritional effects of orlistat.

Can I Take Orlistat With Other Medications?

Possibly, but a medication review is important before treatment begins. Orlistat may affect cyclosporine, levothyroxine, warfarin and other anticoagulants, amiodarone, certain antiepileptic medications, and some HIV treatments. Diabetes medications may also need reassessment as weight and blood sugar change.

Tell your pharmacist or prescriber about all medications and supplements you use. Some products require dose separation or additional monitoring, and certain combinations may not be appropriate.

Is Orlistat Safe for Long-Term Use?

Orlistat has been studied as a long-term weight management treatment, but its suitability depends on an individual’s benefits, side effects, nutritional status, and medical history. Longer treatment may be reasonable for some people who benefit from it and tolerate it well.

Regular reassessment remains important. Your clinician may review weight, relevant medical conditions, medication interactions, dietary adequacy, and symptoms that could indicate adverse effects. The fact that a medication has been used for many years does not mean that everyone should continue it indefinitely without review.

What Are the Warning Signs That Require Immediate Attention?

Seek urgent medical advice if you develop blood in your urine, severe back or groin pain, a major reduction in urination, yellowing of the skin or eyes, dark urine with other possible liver symptoms, or severe and persistent abdominal pain. Difficulty breathing or swelling of the face or throat requires emergency care.

While oily stools and bowel urgency can be expected side effects, severe symptoms, unusual changes, or signs of a serious complication should not be ignored. If you are uncertain whether a symptom is related to orlistat, stop taking the medication when a serious reaction is suspected and contact a healthcare professional for guidance.

What Else Should I Know Before Trying Orlistat?

Orlistat can be a useful option for certain people, but it is not a universal solution. It is most likely to be helpful when someone is an appropriate candidate for medication, understands the meal-related dosing instructions, follows a balanced reduced-calorie diet, and can tolerate the digestive effects.

Consider how well it fits your eating habits. People who already eat balanced meals with moderate portions of fat may find the dietary adjustments more manageable than those who regularly eat very high-fat meals.
Be realistic about the likely benefit. Orlistat generally produces modest additional weight loss on average. It does not block all calories or guarantee a particular result.
Plan for nutritional adequacy. Follow the recommended multivitamin guidance and discuss any concerns about nutrient absorption, existing deficiencies, or dietary restrictions.
Review your medications and medical history. Kidney problems, a history of kidney stones, certain gastrointestinal conditions, pregnancy, breastfeeding, and several drug interactions can affect whether treatment is appropriate.
Do not rely on unverified online products. Use a legitimate pharmacy and confirm that the product contains the stated ingredient and strength. Products sold through unauthorized sources may be counterfeit, contaminated, improperly stored, or incorrectly labelled.
Have a follow-up plan. Monitor progress and side effects and reassess whether the benefits justify continuing treatment. If results are insufficient or adverse effects are difficult to tolerate, other weight management strategies may be more suitable.

Ultimately, orlistat is best understood as a medication that modestly reduces the absorption of dietary fat and may support weight loss when used appropriately. Its benefits are real for some people, but so are its limitations. A realistic diet, appropriate nutritional supplementation, careful attention to side effects, and ongoing professional guidance are essential parts of using it responsibly.

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Citations

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Orlistat-associated adverse effects and drug interactions: a critical review https://pubmed.ncbi.nlm.nih.gov/18095746/

Sjöström L, Rissanen A, Andersen T, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet. 1998; 352(9123): 167-172.

XENICAL – orlistat capsule. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020766s026lbl.pdf

Wang Z, Zhao J, Ma X, et al. Effect of Orlistat on Live Birth Rate in Overweight or Obese Women Undergoing IVF-ET: A Randomized Clinical Trial. J Clin Endocrinol Metab. 2021;106(9):e3533-e3545. doi:10.1210/clinem/dgab340