Xenical (orlistat) People who are severely overweight have a new option to help them shed excess pounds — the fat-blocking drug orlistat (Xenical), which was recently approved by the FDA. Unlike other weight-loss pills that work by tricking the brain into ignoring hunger, Xenical acts in the gastrointestinal tract, blocking enzymes that break down fat. The result: About one-third of the fat a person eats passes straight through the colon without being absorbed into the body. But this isn't a case of having your cake and eating it, too. People who take Xenical can't continue eating high-calorie, fatty foods and expect to lose weight. You have to follow a reduced-calorie diet with 30 percent or fewer of the calories from fat. And Xenical isn't for people who are just a little plump. It's approved only for those who have a Body Mass Index (BMI) of 30 or more. (For example, a person who is 5'5'' would have to weigh 180 pounds or more.) People who have a BMI of 27 or more who also have high blood pressure, high cholesterol or diabetes are also appropriate candidates. Xenical is effective, but not spectacularly so. The most recent study, in the Jan. 20 Journal of the American Medical Association, included almost 900 people (mostly women) who weighed an average of about 220 pounds. While all participants were on a weight-reducing diet, after a year those who took Xenical lost an average of 6.5 pounds more than those who took a placebo. During the second year, all the participants went on a weight-maintenance diet. Those who stayed on Xenical regained seven pounds, compared with the 12.4 pounds gained by those who took a placebo. As is common with most diet studies, a large number of people — nearly half in this case — dropped out of the study before the two years were up. Another benefit was that blood pressure, cholesterol and insulin levels improved modestly in the Xenical group. In light of the serious health concerns that go along with obesity, is it worth trying a diet drug if you're seriously overweight?

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