Far cheaper than the injections, non-hormonal, and with side effects that depend entirely on what you eat.
Explained by a GMC-registered GP, not a leaflet
Honest about what we can and cannot prescribe remotely
Side effects given the same weight as benefits
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Orlistat blocks lipase, the enzyme that breaks down fat in the gut, so around a third of the fat you eat passes through undigested rather than being absorbed.
It acts entirely within the intestine and is barely absorbed into the body — which is why it has no hormonal effects, no effect on appetite, and a safety profile unlike the injectables.
Its side effects are not really side effects at all: they are undigested fat. Eat a low-fat meal and there is little to notice; eat a high-fat one and the consequences are immediate and unmistakable. That feedback loop is, for some people, part of how it works.
Average weight loss is around 3 to 5% of body weight beyond diet alone — modest compared with 15 to 20% on the injectables, but real, and achieved at a fraction of the cost.
Aim for roughly 30% of calories from fat, spread evenly across meals. Loading fat into one meal produces the worst side effects.
People who reduce their fat intake get the results and few side effects; people who do not get the side effects and fewer results. That is the honest summary.
Take a multivitamin containing vitamins A, D, E and K at bedtime, at least two hours from any orlistat dose, since fat-soluble vitamin absorption is reduced.
If you have not lost at least 5% of your body weight by twelve weeks, it should be stopped. A clear decision point rather than an indefinite prescription.
Almost all relate to unabsorbed fat in the gut, and almost all are dose-dependent on what you eat.
These are worst in the first weeks and improve markedly as fat intake adjusts. Being warned in advance is what allows people to plan around it.
Caution applies with type 2 diabetes, where glucose medication often needs reducing as weight falls, and with warfarin.
Yes, within our weight management programme, with the same assessment and review as any other weight treatment.
Orlistat is worth taking seriously rather than dismissing as the weak option. It costs a fraction of the injectables, involves no needles and no hormones, is not in shortage, and has decades of safety data. For some people that combination matters more than the size of the average weight loss.
We will be honest about the trade-off: the weight loss is considerably smaller than with semaglutide or tirzepatide, and the side effects are directly proportional to how much fat you eat.
Orlistat costs a small fraction of what the injectables cost — which for many people is the decisive factor, particularly since weight treatment is long term.
A lower 60mg dose is sold over the counter as Alli, licensed from BMI 28.
It is not subject to the supply shortages that have affected GLP-1 medicines, and there is no counterfeit market of the kind that has grown up around weight-loss pens.
Budget for a multivitamin alongside it.
It can be stopped at any time, and side effects resolve within a day or two. As with any weight treatment, weight tends to return if the eating pattern reverts.
You have not lost 5% of your body weight. That is the licensed criterion and a sensible one — continuing a treatment that has not worked is money and side effects for nothing.
NHS tier 2 and tier 3 weight management services include dietetic and psychological support that private prescribing does not, and that support measurably improves results. We would rather you asked your GP about those first.
For some people, clearly yes. It costs a fraction as much, needs no needles, involves no hormones, and is not in shortage. Average weight loss is smaller — but the best treatment is the one you can actually sustain.
They depend almost entirely on how much fat you eat. With a genuinely lower-fat diet, many people notice little. With a high-fat meal, the effects are immediate and can include urgency and leakage — which you should know before your first day at work on it.
Yes — a multivitamin with A, D, E and K, at bedtime, away from your doses.
It should be stopped. That is the licensed rule, and it protects you from paying for something that is not working.
Yes, at the lower 60mg dose, from BMI 28. The 120mg dose needs a prescription.
Mostly, but levothyroxine must be separated by four hours, warfarin needs INR monitoring, and ciclosporin should not be combined. Tell us everything you take.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 30, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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