OTC orlistat provides a reasonable choice for motivated individuals who can afford the drug (around £55 per month plus the cost of multivitamins). People who want to buy it should receive full counselling about the unwanted gastrointestinal effects and how these relate to diet. Weight regain is likely to be a problem when the drug is stopped and individuals should be advised to discuss long-term weight management options with a healthcare professional at an early stage. (DBT. 2009)The OTC version of orlistat, also marketed as Alli, might in fact be a beneficial addition to a clean diet and a decent exercise program. The mechanism of action, i.e. the prevention of gastrointestinal lipase activity, yet appears highly questionable to me. This is especially true in view of the fact that Alli does not distinguish between "good" and "bad" fats.
The improvements in weight loss which have been seen in a study on 729 adults, cf.
"After 1 year, mean weight loss was greater in those on orlistat 60mg (8.5kg, 8.6%) and orlistat 120mg (9.4kg, 9.7%) than with placebo (6.4kg, 6.6%; p<0.001 for both comparisons). Most of the weight loss was maintained at the end of the second year with orlistat 60mg (6.6kg, 6.8%; p=0.005) and 120mg (7.4kg, 7.6%; p<0.001), and was greater than with placebo (4.3kg, 4.5%)." (DBT. 2009),is thus nothing but the result of artificial calorie reduction. Just eating less bacon would have had the same, if not better effects. My advice is: DO NOT WASTE YOUR MONEY on a pill that merely reduces calories by blocking fat absorption. You need fats, they are not bad, but healthy and without them your hormonal system is about to crash within weeks.
The "fat does make you lean"-paradigm holds especially true for people who are already at a healthy weight and just intend to lose some body fat. For you, Alli or Orlistat is pretty useless, if not counter-productive. A far more effective choice would be intense exercise, a high-protein, low-carb diet with plenty of good fats.