> The manual for Alli makes it clear that orlistat treatment involves aversion therapy, encouraging the user to associate eating fat with unpleasant treatment effects.

Christ. This is like Crohn's disease in pill form. One too many teaspoons of olive oil and you're in for an unpleasant evening...

I remember grabbing a pamphlet when it was new and reading their recommendation to wear dark colored pants and bring a change of clothes to work.

If shitting your pants in the break room is what gets people who can’t control their weight any other way to get to a healthy level, I think that’s worth it.

I want to frame this comment as an example of (the generalized form of) Poe's law.

It’s better to not know.

Jesus Christ on a bike, that’s beyond dystopian, that’s completely f—-ked up.

Does the fda allow that?

Yes, why would the FDA restrict what color pants you wear?

There’s huge tradeoffs people rarely talk about in Medicine. Significant risk of soiling yourself vs a statistically significant reduction in risk of early death isn’t a big deal for the FDA.

In many cases the hell that is chemo is considered acceptable for even moderate increases in expected lifespan. That’s why people started talking healthy life expectancy vs just life expectancy.

Well duh, if you discuss the side effects with patients, they won't take the drug and the drug people won't send you hookers.

Bizarrely enough, the pressure doesn't always go in that direction.

I don't have a colon (but I do still have a functioning anus). The effects from orlistat are very similar to what I experience 24/7. If you're under 30 or so, eventually your sphincter gets much, much stronger and the excess oil stops affecting you nearly as much. You can hold it in indefinitely until your normal "need to go" timing. This takes about a year or so to train, and you'll have quite a few accidents in the meantime.

I still can't eat too much salmon in one sitting though :-( I don't get diarrhea but I do get stuck on the toilet for ages after.

Never trust a fart on orlistat. The horror stories I’ve read of people soiling themselves after eating seemingly normal meals is nuts. On par with Olestra/Haribo sugar-free stories. Also it makes absorbing fat soluble vitamins a huge issue.

The so called Alli-oops.

My favorite fat loss drug along these lines is dinitrophenol. It is the true miracle fat burning drug. It interferes with cellular metabolism in such a way that the body just nonstop oxidizes fat. Fat mass loss in the order of a pound a day or more is entirely possible and some bodybuilders use it to get to a ludicrously low bodyfat percentage. Unfortunately oxidizing that much fat generates a lot of heat, so much that an overdose can be lethal because your body literally roasts itself to death and titration is extremely difficult. Oh and blindness is a common side effect. And for added fun it’s an high explosive. Needless to say it’s not FDA approved.

> And for added fun it’s an high explosive

Better not tell that to all the cardiac patients on nitroglycerin.

Also when you eat on it you are punished by heating up even more.

Permanent blindness?! Ffs

Honestly GLP-1 agonists will save lives just by being the go-to replacement for people who previously would have used DNP. GLP-1 agonists are effective enough that everyone in those circles basically stopped using DNP suddenly a couple years ago.

Is this the one? :)

https://en.wikipedia.org/wiki/2,4-Dinitrophenol#Toxicity

You want to know what's even crazier, you can literally but it over the counter. I was at kroger the other day and I saw it next to the vitamins and I did a double take.