A few weeks ago, I had the opportunity to meet alli user Cheryl H. as we filmed alli's latest commercial in her house (yes, in her house).  We chose her for the ad after reading the story that she submitted to the real stories section of myalli.com. 

Cheryl works as a pharmacist at a local independent pharmacy, she is married with two teenagers, and volunteers in her community. Like many of us, she juggles a busy schedule and did not want to take something that would reduce her ability to focus.

Being an alli user who is also a pharmacist, she is also able to share her experience with people that come into her pharmacy for help.

"When people come into the pharmacy and ask questions about any medication, it's always easier to talk about their concerns when I have actually had a personal experience with the medication myself. Since I have had personal experience with alli, I know all the ins and outs. I just tell them, if you eat right it's going to work for you, too. It's something that you're going to be able to do to keep the weight off because you change the way you eat. Unlike with other diet medications, Alli motivates you to make the necessary lifestyle changes that will make it possible to keep the weight off."

alli has sold over 2 million starter packages to date (and adding tens of thousands every week). That's a lot of people learning how to eat better (fewer calories in) and get more active (more calories burned).

As Margaret Meade said, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." 

I'm following anecdotally (I can't read everything) what the hundreds of thousands of people who started using alli in June have to say about this new and unique combination of a fat blocker and food education program. To date, over 100,000 messages have been left on the official alli message board. Over 5 million unique visitors have visited the product Web site, myalli.com.

In addition, tens of thousands of users are talking to each other about alli in blogs and online discussion groups they've formed themselves. One of the biggest is alli allies on Weight Watchers. See our new blogrolls in the right-hand column for more links to online communities.

Can these two million alli users change the way Americans define meaningful weight loss and how best to go about it? Can a committed group of Americans combat weight loss myths? Is it a revolution yet??

P.S. The screen grab above is from our public service Web site questioneverything.com (short for "question everything about weight loss"), which started the ball rolling before alli launched by providing food education and provocative discussions about weight loss myths.

If you have a question about the alli program, let me know.

N.B. See this new GSK study reporting on product satisfaction from controlled clinical trials.

It's a legitimate question. Is alli really needed? If eating low-fat (and fewer calories) and exercising more is the best route to weight loss, then why, really, do you need a pill like alli to help you along?

I'm hearing this question asked in numerous ways, both online and off. I heard it asked in a focus group last week. A doctor blogs about it here.

Here's my answer: If you're going to make a serious, extended effort to cut calories and fat, and to get more physically active, then WHY WOULDN'T YOU add alli? To put it another way, why wouldn't you go for a 50% better return on your weight loss effort?

If you're buying 10 gallons of gasoline, would you turn down a free coupon for an extra five gallons?

If you think about how alli works (it blocks about 25% of the fat in your meal, helping you lose 50% more weight), then not taking alli is like turning down a coupon for five extra gallons when you're already paying for ten gallons of gasoline. Or turning down the 50% more free toothpaste in that bonus tube. Obviously, using alli is not as simple as brushing your teeth or buying gasoline. You have to read the label to make sure alli is right for you. But, the point is still the same. In simplest medical terms, alli helps enhance the calorie deficit that is necessary to lose weight. 

I can tell you that I appreciated the extra help when I used orlistat (the active ingredient in alli) to lose 60 pounds over three years (I've kept it off).

By the way, here's a useful resource on Revolution Health that intelligently offers pros and cons about using alli. And not to sound like a commercial but I have to say it: more about whether alli is right for you on myalli.com (safety information and FAQs).

And if you've got a better analogy for "why use a pill" than gasoline coupons or toothpaste, let me know.

If we're going to make progress in helping millions of people lose weight, isn't it about time that the news media, providers of weight loss programs, and others (yes, that might be a pharmaceutical company) influence the public to adopt more realistic expectations about what makes weight loss meaningful?

Number of pounds lost should not be the only yardstick of success

Medical science has proven that even a modest amount of weight loss is beneficial if you're overweight. Losing more, like 5% of your weight, leads to significant improvements in your health. That's why the government requires new weight loss drugs to meet or beat this standard. 

If even modest weight loss is beneficial, why do we expect so much when we begin a diet?

When we've asked people "how much would you like to lose", they give answers that reflect their aspirations versus what they think is realistic. I've sat through dozens of focus groups and have seen this first hand. And I suspect that when dieters fall short of unrealistic goals, they have even higher expectations the next time - creating a vicious cycle.

In fact, the vicious cycle does exist. A study [links to PDF] that we conducted with the University of Connecticut found that people distinguish between "ideal" and "realistic" weight loss.

Odds are, if you are reading this, you probably know what a treatment effect (TE) is and why they can happen. And yes, we have been very open about TEs in our marketing of alli. USA Today even writes about our sense of scatalogical humor.

But is there really a benefit to using a product that could result in treatment effects? Many cynics say no, but new users of alli disagree. Some people have even been rethinking treatment effects. Not because they're unpleasant, but because TEs are keeping them honest. The USA Today article makes that point too.

What do you think? Can treatment effects increase motivation for people really committed to losing weight?

alliFirst Team member Caryn Eyring (left) told People Magazine she's lost 21 pounds since she started taking alli in April, along with "cutting fat [and] doing yoga."

She's quoted in the July 9, 2007 issue of People (page 77) with a post-jail Paris Hilton on the cover. Caryn had one  "alli-oops" episode after eating a chicken with crispy noodles appetizer, according to People. alli, she says in the article, "is forcing me to eat healthier."

Yup, alli will punish cheaters if you don't stick to a low-fat diet. But isn't that the whole point... to encourage a healthier way of eating? As another alliFirst member, Paula Miguel, told People: "If I stopped taking alli today, I would still keep those new habits."

Oh and just a reminder that coverage of the alli program by People Magazine is not an endorsement. 

The crux of the alli plan is that you have to eat a sensible, low-fat, reduced-calorie diet and get a moderate amount of exercise while taking the capsules.

For those interested in following a diet program or plan, here are the pros and cons of using alli with popular diets - from the very low-fat to the low-carb, high-fat .

As the graph from the Companion Guide inside the alli package shows (click on the image above), you want to avoid diets very high in fat like the Atkins program. Why? You'll get treatment effects like loose stools and have to get to the bathroom very quickly. alli blocks 25 percent of the fat you eat so the more fat you take in, the more fat needs to come out the, er, other end.

By the same token, you want to avoid diets that are very low in fat, like Pritiken, since there's little or no fat to block. 

The good news is that there are many diet programs that work in combination with the alli program.  Commercial weight loss programs like Weight Watchers, Jenny Craig or Nutrisystems all have low-fat reduced calorie options that are compatible with alli.   

This is not an endorsement of any of these diet programs. And they haven't endorsed alli.  Just an explanation.

You may be hearing from a select group of people who started using alli in April. We're calling them the alliFirst Team. They are 400 overweight adults - men and women - whom we recruited as eager volunteers to try the alli program.

Hundreds of clinical studies have been done on Orlistat, the active ingredient in alli - but we wanted to get some early feedback based on "the real world."  You may have seen comments about alli on other sites.  alliFirst members have set up their own online communities (on SparkPeople, for example) to share ideas and help each other. 

The alliFirst members have received many of the same educational tools that will be available this coming Friday when alli hits store shelves.  They've also received a six months supply of alli to compensate them for their advice - but their opinions are their own.

Read on for the invitation letter we sent to the alliFirst Team to come check out this blog.

Letter sent to alliFirst Team members

Dear alli First Team:

We would like to invite you to be among the first to visit our blog at alliConnect.com.  The alliConnect blog is a place to talk about weight loss with the alli brand team.  You are welcome to leave a comment, but you don't have to.

You should keep in mind that if your comment is published, it will appear on a public web page and will be seen by others.  So you should be careful about revealing too much personal information. 

However, we would like you to identify yourself as someone who is part of the alli First Team - a special group of consumers who are already using the alli weight control capsules and program.  And as always:

- express only your own opinion

- share only your own experiences; do not write about others on the team

- comment on what you know from personal experience; do not speculate or fabricate

- disclose that you have received product at no cost but that you are otherwise not compensated by GSK, the makers of alli

- be respectful and thoughtful; your comments will be read by many

We continue to value your insights, opinions, suggestions and appreciate your dedication to the alliFirst team.

Sincerely,

Karen L. Hill, Associate Brand Manager, Weight Control
GlaxoSmithKline Consumer Healthcare

Here's my oops story... Consider it a cautionary tale. But also take heart. It wasn't that big a deal. And it only happened once. (I've even talked about it on CNBC.)

Treatment effects are common if you eat meals with too much fat. They aren't a safety concern - they won't hurt you. But they could be embarrassing if you aren't prepared to deal with them.

The rule of thumb is to limit your calories from fat to about 30% per meal, or about 15 grams of fat per meal. 

I learned this the hard way when I ate a fish sandwich and french fries from a fast food drive-through WITH TARTAR SAUCE, and a soda.  Really smart, huh? 

Good thing I was close to home so I could change my clothes.*  But you know what?  It hasn't happened since. 

Yes, I still see occasionally undigested fat floating in the toilet. But I'd rather have the fat flushed away when I go to the bathroom than have it wrap around my waist or clog my arteries. 

Studies show that about one out of every two alli users in a real world setting (real world, meaning you're on your own, versus being part of a "controlled clinical trial" where you get lots of instruction and advice) don't even get treatment effects.  Those that do should expect to experience a "signal" that alli is working to block excess fat- but very few people (something like 5%) stop using the program because of how the product works.

Over time (I've lost 60 pounds and kept it off for about three years) I've learned to make changes in the way I eat. I still enjoy steak and potatoes - but I pick filet or strips versus rib eyes, and pass on the butter.

* My oops experience happened surprisingly quickly. That's not typical. The delay between eating a high fat meal and experiencing treatment effects varies from person to person but is generally 12 hours.

You may have heard about the book are you losing it? and wondered what it was all about.  If you've seen it, odds are you found it in places you wouldn’t expect... like your local pharmacy counter or on the shelf in the weight loss product aisle (while supplies last).

This is not a money-maker for GSK. We've pledged all of the profits from the book to help prevent childhood  obesity through programs offered by Shaping American’s Health and NAASO, the Obesity Society.

If you want to learn more about the book, go to areyoulosingit.myalli.com.  Keep in mind that the book isn’t just about alli - only 21 of the 150+ pages talk about the alli program.  But, one of the pages does include information about the alli treatment effects (page 69), as mentioned by CNBC's Mike Huckman.