>Cross-posted at BlogHer:

Filed under "Who Didn't See This Coming?:" The US Federal Drug Administration (FDA) is investigating reports that alli, the only FDA-approved nonprescription weight-loss drug, caused liver damage, according to The Washington Post. (Man, if that sentence wasn't a mouthful, I don't know what is. Except, of course, that people using alli can't have a mouthful because of how alli works, but more on that later.) While there is no conclusive link, more than 30 people using alli and Xenical, its stronger prescription sibling, were hospitalized with liver issues between 1999 and October 2008.

OK, so people using alli (pronounced like "ally" - clever, no?) can really eat a mouthful, just so long as said mouthful doesn't contain too much fat. This is because alli "works" by stopping a person's body from absorbing fat. Anyone remember Olestra and "anal leakage" side effect? Yeah, it's like that. But worse. Basically, if you make a mistake and consume too much fat while using alli, you will essentially shit yourself. I'm sorry, there's no nicer way to say it. What distresses me about alli is that a lot of people (especially women, who alli is primarily marketed towards) are so desperate to be thin (and also continue eating what they want to) that crapping their undies is a better option than, god forbid, being overweight. (And let's not confuse overweight with healthy because they are often very different things. Certainly someone who is thin but uncontrollably poops through her thong is less healthy than someone who is overweight but can control her own bowels. Plus, studies have shown that what people we consider "overweight" are actually healthier than people considered a "healthy weight", but that's another story.)

BlogHer Health and Wellness Contributing Editor Catherine Morgan blogged about alli back in July 2007, noting that 1. FDA approval of the drug concerned her, as many drugs get approval and then are shown to be unsafe; and 2. "Limiting your fat intake per meal WILL facilitate weight loss, even without a pill that gives you diarrhea. She also pointed out that the only way to sustain weight loss is through a healthy diet. For these excellent insights, she was raked over the coals by some commenters. (Several claimed that people who eat too much fat - whether on alli or not - are at fault because they have no willpower or self-restraint. Another person demanded that she present her medical credentials for making such a ridiculous argument. Seriously.)

Although I clearly am irritated that people would attack Catherine's scientific, evidence laden post, I understand why. We live in a world we are pounded day in and day out with messages about body acceptability. We are also bombarded nearly 24-7 with ads selling tasty foods. At the same time, busy schedules, socio-economic pressures, and other issues may preclude people from having access to fresh foods, the time to prepare meals, and ways to exercise. These are not excuses, they are realities. And the reality is that drug manufacturers take advantage of our insecurities by selling us miracle pills to make us thin. Is GlaxoSmithKline, the distributor of alli, any better than a snake oil salesman peddling his wares from his wagon at the turn of the century? No, both sold people easy access to things that were and are just out of reach.

I'm not going to lie: I'm no more immune to the pressure to be thin than anyone else. No matter what I look like, I always think I am fat, except for a period of time about seven years ago. I had been having various digestive issues for almost a year and seeing a gastroenterologist, when one day I came home from work and needed to use the toilet maybe more urgently than I ever did in my entire life. When I was done, I was horrified to notice orange grease floating in the toilet. (As this is a family blog, I won't describe what else was in it.) For the next six months, whatever I ate slid out of me undigested like it was a vat of Olestra. I lost a lot of weight, quickly. And despite the fact that I was becoming nutritionally deprived, smelled from gas, had constant cramps, and my ass hurt from the amount of wiping I needed to do every time I used the bathroom - and I mean every time I sat on a toilet, something very bad came out of me (TMI, I know - sorry) - I liked how I looked. At least I liked how my body looked in a tight pair of jeans. My face looked like a zombie because I was seriously ill.

Many unpleasant tests later (for details, see Part I and Part II, but warning: it involves collection buckets and a refrigerator), no one understood why I naturally produced the as-yet-uninvented-alli, and I was warned to be very careful about how much fat I ate. The bottom line is that not digesting fat is really, really unhealthy. That's why I am not surprised that alli may cause liver damage.