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Eating disorder patients might be tempted to abuse the first FDA-approved nonprescription diet pill
In February the FDA approved Alli, an over-the-counter (OTC) version of orlistat (Xenical). Alli is expected to arrive in drugstores this month. The advent of America's first FDA-approved nonprescription diet pill likely will assist some people attempting to lose weight because of the medical risks associated with obesity. Yet because Alli will be readily available, some patients with eating disorders likely will abuse this medication and potentially incur dangerous medical side effects.
Research suggests that people with eating disorders regularly abuse OTC diet products to control weight and suppress appetite. Between 28%' and 64%' of eating disorder outpatients might use such products to control weight and appetite. The percentages of adult and adolescent eating disorder patients who abuse OTC products are similar. Eating disorder patients continue to use such products despite adverse side effects2 and despite the fact that no OTC diet product (until now) has FDA approval or established efficacy for weight loss or appetite suppression. Yet because Alli has FDA approval as a diet aid and because orlistat is known to increase weight loss among dieters by as much as 40%,3 it is possible that even greater percentages of eating disorder sufferers will misuse Alli.
In fact, several case studies have documented orlistat abuse among patients with eating disorders. Normal-weight patients with bulimia nervosa have abused orlistat as a purging mechanism.4'1 Patients who initially meet criteria for binge eating disorder but who misuse orlistat to purge may develop full-blown bulimia nervosa,5 a more serious illness.
Research has demonstrated that orlistat entails a range of side effects (table). Although Alli will be of reduced strength relative to prescription orlistat, when patients abuse diet products they typically take larger than recommended doses, perhaps as much as ten times more than recommended doses.7 Hence, the actual ingested dose of Alli for many eating disorder patients may exceed the strength of prescription orlistat. As a result, the known side effects of orlistat may be even more severe or more common in those who abuse Alli.
One of orlisrat's unpleasant side effects is diarrhea, but this might not dissuade eating disorder patients from abusing Alli. As much as 26%8 of eating disorder...