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The invisible woman
As age creeps into my body, my hands keep creeping into younger men's pants.
By Virginia Vitzthum
[06/29/99]

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"Living in the Lightning: A Cancer Journal"
One woman learns how to manage her fear.
By Natalie Robins
[06/28/99]

Sexpert Opinion
Still insatiable
Porn legend Marilyn Chambers makes a steamy comeback.
By Susie Bright
[06/26/99]

Is it in the genes?
Studies suggest human behavior isn't as predetermined as some thought.
By Arthur Allen
[06/25/99]

I was a junkie stockbroker
How one trader learned that there's more to life than the vicissitudes of the market.
By Bolt Edsall
[06/24/99]

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By Sharon Lerner

June 30, 1999 | If you'd prefer that last night's crème brûleé end up in the toilet instead of on your hips, you might take orlestat. The new drug, which came on the market less than two months ago, arranges it so that one-third of ingested fat goes right through you, so to speak.

Orlistat, sold under the brand name Xenical, has only been FDA approved for -- and tested in -- those who are officially obese. One of these, Cindy Smith, could be the Xenical poster child. The new fat-blocking drug helped her take off hated pounds she had been unable to lose any other way. At 5 feet 4 inches tall, she weighed 220 pounds when she entered clinical trials of the drug two years ago. Now the 34-year-old bank worker in Houston is a satisfied 150.

To qualify for the trials, you had to be, like Smith, officially fat. At 6 feet tall, for example, participants had to weigh at least 220 pounds, or no less than 200 if they had fat-related health problems. After two years of testing, it appeared that overweight people who took the drug lost an average of seven to 10 pounds more than those who didn't. Xenical also lowered levels of problem cholesterol beyond what could be explained by the weight loss.

For the desperate to reduce, such benefits may justify the fact that Xenical is chemically addressing what is essentially a social problem. In a rational world, one might suggest not eating whatever you don't want to digest. But in our culture, at once obsessed with both food and thinness, the blue capsules are being embraced as a way of tempering the consequences of excess. And not just by the truly overweight.

More than 210,000 Xenical prescriptions have been sold in the drug's first seven weeks on the U.S. market. Apparently the appeal of the fat-be-gone pill trumps any memory of the recent recall of fenfluramine, another diet drug that was shown to cause heart damage after being pounced on by eager dieters. It also overshadows Xenical's own hazards, which are many and troubling.

In fact, the FDA panel considering Xenical was at first split on whether to approve it, with nay-voters stuck on distressing medical points, such as the fact that the drug leaches vitamins from the body and disrupts the normal digestion process. Perhaps most alarming, one study the panel reviewed found that drug takers had a higher rate of breast cancer than those not on it. New data that the breast cancer cases didn't appear to be linked to the drug eased panel members' concerns enough for them to approve Xenical in May. But even after approval, Jules Hirsch, an internist and nutrition expert who served on the panel, says "there is a residual worry" over the breast cancer question.

And, since Xenical has been only tested for two years, its long-term effects add up to a big question mark. "We don't know what this drug does over long periods of time to gastrointestinal function," says Hirsch. "It's coating the intestine with a thin layer of fat. We just don't know what this will do to intestinal function over years."

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