6 Mistakes People Make When Taking Orlistat

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Orlistat is an FDA approved drug for weight loss. There are many people who use it, and eventually decide that it’s not working for them, which is fair enough.

But before you throw in the towel and look for something else, are there reasons it’s not working for you?

Let’s take a look at some reasons why you might not want to take orlistat, or why orlistat might not be working well for you.

What is orlistat?

Orlistat, also known as Xenical or Alli, is a drug that blocks fat absorption in the body. A more in depth video on how it works and what you can expect can be found down in the description below.

Being one of our oldest medications for weight loss, it’s a drug very commonly used around the world.

So from the experiences of many of my patients who have tried orlistat, here are some common reasons why it didn’t work for them or why they stopped taking it.

Reasons why orlistat isn’t working

1.) Underestimating the side effects

Orlistat will cause fat malabsorption, causing fat to end up in your stool.

If you’ve never experienced orange-colored, fatty, oily stools, or being unable to fully control your bowels, you could be in for an embarrassing and unpleasant surprise.

Sometimes patients underestimate the social ramifications of having to go to the washroom at a moment’s notice, especially if they’ve eaten something they shouldn’t have.

Leakage of stools onto underwear is also common, and may only be discovered when changing clothes, which could come as quite a shock since some patients don’t even feel the leakage.

Even if you’re following the recommended low-fat diet, you could still experience some of those side effects.

So if you’re unprepared to deal with them, you might not want to continue orlistat.

2.) Not following a proper diet

Orlistat is meant to be used with a low-fat, calorie controlled diet. It only blocks around 30% of the fat you eat, meaning if your diet is too high in fat, you’ll still absorb most of it.

However, not every low-fat diet will work with orlistat.

For example, if you’re consuming too many calories from simple carbs, like from pasta, bread, juice, or pop, orlistat won’t block the absorption of those foods at all, and you’ll need to both cut down on those carbs and replace them with some complex carbohydrates.

Keep in mind that low-fat does not mean no-fat. You actually need some fat in your diet for orlistat to work, since only then will orlistat have something to block.

No-fat diets will not work with orlistat since orlistat will have nothing to block.

Diets that tend to work well with orlistat include:

• low carbohydrate diets
• high protein diets
• high soluble fiber diets

Some examples would be a low-carbohydrate Mediterranean diet, or a mostly vegetarian diet that allows for dairy, fish and eggs.

Orlistat, like many of the other weight loss medications, are only a tool, and can help you to lose weight, but cannot replace the foundations of proper weight loss, like diet and exercise.

3.) Improper dosing

Orlistat is meant to be taken up to three times a day, during or up to 1 hour after each meal.

The timing of when you take orlistat is important, as it works locally to block fat.

Take it too early and the drug exits your body without doing anything.

Take it too late and the food has already been absorbed.

Remember it’s up to 1 hour after your meal, so try to take it within that time period, not a full hour afterwards.

It’s frequently recommended that you take orlistat with meals that contain fat.

Some patients will skip dosing on meals they believe have little to no fat.

While this makes sense in theory, in reality, many patients underestimate the amount of fat in their meal, and mistakenly skip dosing thinking it won’t make a difference.

If you’re having 3 meals a day, and only taking orlistat during dinner, because your breakfast and lunch are small, or you’re frequently skipping doses to avoid the side effects during the day, it’s not too surprising orlistat isn’t working properly for you.

Take orlistat as it’s meant to be taken, with each meal, up to three times a day.

It also comes in two forms, Xenical, which is 120 mg, and Alli, which is 60 mg. In my experience, the increased dosing in Xenical does make a significant difference for weight loss. The lower dose in Alli makes it more tolerable, but quite a bit less effective.

4.) You’re snacking too much

Because orlistat is dosed only with meals, if you’re snacking and grazing throughout the day, all the food you’re consuming outside your meals won’t be affected by orlistat, and it won’t work well for you.

You’ll need to either control your snacking or otherwise limit your food intake to 2-3 meals per day.

If you’re drinking too many calorie dense liquids like juice, pop, or milk outside of your meals, this could be a problem as well.

Focus on just water, tea, or coffee with no milk or sugar outside of your meals with orlistat.

5.) Nutritional deficiencies

Orlistat can block the proper absorption of certain nutrients, particularly fat soluble vitamins like Vitamin D.

If you’re fatigued all the time, and your diet is too limited, it’s possible that nutritional deficiencies are hindering the ability of your body to properly burn fat, and negatively affect your weight loss.

Nutritional supplements or Vitamin Injection Therapies can help to replenish some of these nutrients easily, if you aren’t able to obtain them from your diet.

6.) You’re expecting miracles

Orlistat blocks fat absorption, and it won’t really control your appetite or cravings, unlike Saxenda or Contrave, so you won’t really feel its effects for weight loss.

But that doesn’t necessarily mean it isn’t working.

Orlistat also tends to have less drastic weight loss effects compared to other weight loss medications, meaning the weight typically won’t come off as quickly.

The average weight lost on orlistat is also modest, with patients typically losing around 3-5% of their current body weight over a few months. So you’ll need to manage and set realistic expectations.

Also, orlistat does not work well without a weight loss diet at all. And while some other weight loss medications may initially work for a little while, even without much of a diet, all medications will eventually stop working long-term if you lack a good weight loss diet, regardless of which medication you’ve used.

So if long-term weight loss is your goal, the differences in the effectiveness of different FDA approved weight loss drugs are a little less important if you have a good overall weight loss plan in place.

Learn more about

• What to Expect with Orlistat
• The BEST Diets on Orlistat
• Other weight loss medications

See also

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• 
  Comparing Weight Loss Drugs in 2024
  Ozempic and Mounjaro are highly effective at treating obesity, however there are many other approved and off-label options that also work.
• 
  Bupropion vs Contrave vs Naltrexone
  Contrave is a synergistic combination of buproprion and naltrexone, which can be replicated to some degree using the generics individually.
• 
  New Obesity Drugs in 2024
  New obesity drugs target more than just GLP-1 and do much more than suppress appetite for a more nuanced approach to weight loss.
• 
  Mounjaro: Who Loses the Most Weight?
  White or Asian younger women who use metformin and have lower sugar and lipid levels tend to experience more weight loss with Mounjaro.