Vain versus fat — can there ever be a compromise?

Friday, June 15 marked the nationwide release of a new over-the-counter weight-loss drug called Alli. The drug is the first of its kind approved by the Food and Drug Administration (FDA) for over-the-counter sale.

Alli works to block the body's uptake of fats in the gastrointestinal tract. In clinical trials, weight loss from diet and exercise was augmented by an average of 50 percent for study participants taking the drug compared with those not taking the drug.

Alli has been marketed previously under the name Xenical, a drug with the same active ingredient but twice the dosage. Xenical has not sold well due to poor marketing and undesirable side effects.

Before hitting shelves, the new version got a marketing makeover.

GlaxoSmithKline, the drug's manufacturer, has gone to great lengths to ensure that consumers know exactly what they are getting when they buy Alli.

The drug is not a substitute for a healthy diet and exercise, says the company, and its effects are not dramatic. GlaxoSmithKline even went so far as to open a museum-like marketing display at the end of May in New York City to educate consumers about what to expect from the drug.

This is all fine, and, admittedly, a lot more responsible than most new drug advertising campaigns. But don't overlook the manufacturer's warning about side effects — those didn't get a makeover.

Xenical's reincarnation still carries the same risks as the original. What risks, you ask? In essence, "look out for number two."

Fat blocked by Alli is passed by the digestive system. The catch is that this can happen at unwanted and perhaps unplanned times. The company even suggests that consumers bring an extra pair of pants to work when they start taking the drug.

Late night comedians have had a great time with that last bit and probably with good cause. Are a few extra pounds of weight loss worth soiling oneself? That seems to be the question of the day.

Alli has been proven to help its users lose weight, but at what cost, and for that matter, at what gain? Most prospective customers could reach the same weight loss goal without Alli — it would only take about 50 percent more exercise and healthy eating.

In these terms, the drug is a substitute for exercise and a healthy diet, a shortcut for those unwilling or "too busy" to exercise without the drug.

Alli may be additionally unique in this regard. The drug is suggested for anyone with a body mass index of 25 or higher — approximately two-thirds of the U.S. population, according to The Associated Press. More than half of the nation is suddenly qualified to medicate itself for weight loss.

That is to say, this drug is not about a patient-doctor decision. Medical professionals have been essentially removed from the equation.

Weight loss medication is no longer only for those with a professionally determined need. It's for anyone who's a little overweight and feeling a little vain (and has an extra pair of pants).

Even worse, the FDA's approval of the drug for over-the-counter sales is a bit questionable. The manufacturer recommends a daily dosage of one to three pills.

Maybe I don't get the chemistry, but I have a hard time understanding how two or three doses of Alli isn't like one dose of Xenical, which, you'll recall, is prescription-only.

Ultimately, the greatest deterrent (besides the pants thing) to Alli may be the cost. Depending on dosage, it costs about $1.50 per day.

Isn't that the same as sponsoring one or two of those orphans in Southeast Asia?