Guidelines Backlash, the Biggies — Drugs, Part 4

In Part 1 of this series we mentioned orlistat, the generic name of one of the six kinds of drugs that the Food and Drug Administration has approved specifically for weight loss. As all pharmaceuticals of this type must warn, it is “Only effective as an adjunct to caloric restriction, increased physical activity, and behavioral modification.”

According to the manufacturer’s description,

Orlistat is a gastrointestinal lipase inhibitor that works by blocking the absorption of 25% of the fat in a meal and is used for weight loss in overweight adults, 18 years and older…

But that statement is misleading because it’s outdated. True, the substance’s safety and efficacy have not been established for children under 12 years old, and apparently it is not authorized for them. Which means, it is able to be prescribed for young persons over 12, to be taken by mouth every eight hours. And guess what? A half-strength version of the drug is available over the counter!

Another source says that for that age group,

A 6-12 month trial of orlistat… may be appropriate after specialist assessment, particularly in morbid obesity… or when co-morbidities exist, although evidence for long-term effectiveness in this age group is lacking.

A common side effect of its use is oily leakage that stains the undergarments, which results from another side effect, flatulence (gas) with discharge. The child might defecate more frequently, and the stools produced might be fatty, oily, painful, loose, liquid, clay-colored, or uncontrollable. A child who was previously picked on for being fat might have the chance to experience something new and different, the mortification of being picked on because they pooped their pants.

Then there is the possible onset of nausea, stomach pain, vomiting, weakness, itching, skin rash, dark urine, loss of appetite, jaundice, headache, and/or back pain. There might be problems with the teeth and gums, liver failure, or the whole spectrum of cold/flu symptoms, including chills and fever. The child might come down with a fancy ailment like oxalate nephropathy or leukocytoclastic vasculitis.

Orlistat has been known to interact mildly with at least 21 other drugs, and to interact moderately with at least 65 different drugs. To top it all off, the manufacturer cautions, “This information does not contain all possible interactions or adverse effects.” Orlistat is classified as a Gastrointestinal Agent and also, as Other. Maybe Other is code for “Let’s hope this is never authorized for younger kids.”

Your responses and feedback are welcome!

Source: “Orlistat,”, 08/27/21″
Source: “Preventing Childhood Obesity: Evidence Policy and Practice,”, 2010
Image by Michael Saechang/CC BY-SA 2.0

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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