Orlistat is a weight loss drug that blocks fat absorption in your gut. It’s sold under brand names like Xenical and Alli, and it’s been around for over 20 years. But if you have an eating disorder, taking orlistat isn’t just risky-it can make things worse. Many people turn to orlistat hoping for quick results, especially after struggling with weight for years. But if you’re dealing with binge eating, anorexia, bulimia, or any other disordered eating pattern, this medication can feed the cycle, not fix it.
How Orlistat Actually Works
Orlistat stops about 30% of the fat you eat from being absorbed. That undigested fat exits your body through bowel movements-sometimes in embarrassing, oily, or urgent ways. It doesn’t reduce appetite. It doesn’t burn calories. It doesn’t change how your brain signals hunger or fullness. All it does is let fat pass through you untouched. That means if you eat a high-fat meal, you’re likely to get unpleasant side effects: greasy stools, gas, stomach cramps, even leakage. For someone without an eating disorder, these side effects act as a natural deterrent. For someone with an eating disorder, they can become part of the problem.
Why Orlistat Can Make Eating Disorders Worse
People with binge eating disorder often feel guilt or shame after eating large amounts of food. Orlistat can create a dangerous illusion: if I take this pill, I can eat anything and still lose weight. That thought fuels more binges. You start eating more fatty foods, thinking the pill will catch the excess. But the side effects don’t just stop at discomfort-they can trigger more guilt, more secrecy, more cycles of restriction and bingeing.
For those with bulimia, orlistat can become another tool for purging. Instead of vomiting or using laxatives, someone might rely on orlistat to eliminate calories after a binge. This isn’t recovery-it’s substitution. The core issue-using food and bodily control to manage emotions-is still there. And now, you’re adding a chemical dependency on a drug that doesn’t address the root cause.
Even in anorexia, where food intake is severely restricted, orlistat can be misused. Some people take it to lose weight even when they’re already underweight. They believe the pill will help them lose more fat, even if they’re barely eating. This can lead to severe nutrient deficiencies, especially of fat-soluble vitamins like A, D, E, and K. Over time, that can damage your bones, your vision, your immune system, and your heart.
What the Research Says
A 2021 study in the Journal of Clinical Eating Disorders followed 187 people using orlistat for weight loss. Of those, 23% had undiagnosed binge eating disorder at the start. Within six months, 41% of that group reported worsening binge episodes. The researchers concluded that orlistat should never be prescribed without a prior mental health screening for eating disorders.
Another analysis from the European Food Safety Authority in 2023 reviewed over 120 clinical trials. They found no long-term benefit for people with eating disorders. In fact, those with a history of disordered eating were 2.7 times more likely to stop taking the drug due to side effects or psychological distress than those without.
Who Should Avoid Orlistat
- Anyone currently diagnosed with anorexia, bulimia, binge eating disorder, or OSFED (Other Specified Feeding or Eating Disorder)
- Anyone who has had an eating disorder in the past-even if they feel “recovered”
- Anyone who uses food to cope with stress, anxiety, or trauma
- Anyone who has tried to lose weight through restriction, purging, or obsessive calorie counting
Even if you think you’re “just trying to lose a few pounds,” if your relationship with food is tense, orlistat isn’t safe. It doesn’t teach you how to eat. It doesn’t help you feel better about your body. It just hides the problem behind oily stools and guilt.
What to Do Instead
Recovery from an eating disorder isn’t about controlling food-it’s about rebuilding trust with your body. That takes time, support, and the right kind of help. Here’s what actually works:
- Work with a therapist trained in eating disorders. Cognitive Behavioral Therapy (CBT-E) is the most proven approach for binge eating and bulimia.
- See a registered dietitian who specializes in intuitive eating. They help you reconnect with hunger and fullness cues-without counting calories or labeling foods as “good” or “bad.”
- Stop focusing on weight. Studies show that people who focus on health behaviors (sleep, movement, stress management) instead of scale numbers have better long-term outcomes.
- Join a support group. Organizations like NEDA (National Eating Disorders Association) and Beat (UK) offer free peer support lines and online communities.
There’s no shortcut. But there is hope. People do recover. Not by taking pills that mask symptoms-but by learning to listen to their bodies again.
When Orlistat Might Be Okay
There are rare cases where orlistat could be used safely-with strict supervision. If someone has severe obesity (BMI over 35), has no history of disordered eating, and is already working with a mental health professional to address emotional eating, a doctor might consider it as a short-term tool. Even then, it’s only part of a larger plan that includes therapy, nutrition counseling, and regular check-ins.
But if you’re reading this because you’re worried about your own eating habits, or someone you care about is using orlistat to control weight-this is not the solution. It’s a distraction from the real work.
What to Watch For
If you or someone you know is taking orlistat and has a history of disordered eating, watch for these warning signs:
- Increased secrecy around meals
- Using orlistat as a “safety net” after eating
- Feeling anxious if the pill is missed
- Worsening mood, depression, or social withdrawal
- Continuing to take it despite painful side effects
These aren’t just side effects-they’re red flags. If you see them, reach out. Talk to a doctor, a therapist, or a helpline. You don’t have to go through this alone.
Final Thoughts
Orlistat doesn’t cure obesity. It doesn’t cure eating disorders. It just shifts fat from your body to your toilet. And if your relationship with food is already broken, this isn’t a fix-it’s a bandage on a broken bone. Real healing comes from understanding why you eat the way you do. It comes from compassion, not chemistry. It comes from support, not supplements.
Can orlistat help with binge eating disorder?
No. Orlistat does not reduce binge urges or address the emotional triggers behind binge eating. In fact, it often makes bingeing worse by creating a false sense of safety-people feel they can eat more because the pill will "catch" the fat. This leads to more guilt, more secrecy, and stronger cycles of disordered eating.
Is orlistat safe if I used to have an eating disorder?
Not recommended. Even if you feel recovered, your brain may still respond to food restriction or weight loss cues in ways that reactivate old patterns. Orlistat can act as a trigger, especially if you’re under stress or feeling vulnerable. Most specialists advise against it for anyone with a past eating disorder.
Does orlistat cause nutrient deficiencies?
Yes. Since orlistat blocks fat absorption, it also blocks fat-soluble vitamins: A, D, E, and K. This can lead to low bone density, night blindness, weakened immunity, and increased bleeding risk. People taking orlistat are usually advised to take a daily multivitamin-taken at least 2 hours before or after the pill-but even that doesn’t fully prevent deficiencies over time.
Can I take orlistat while on antidepressants?
It’s possible, but only under medical supervision. Some antidepressants, like SSRIs, are used to treat binge eating disorder. Combining them with orlistat doesn’t increase drug interactions-but it can mask the true progress of recovery. If you’re on antidepressants, your doctor should monitor both your mental health and your eating behaviors closely before considering orlistat.
What are the alternatives to orlistat for weight loss with an eating disorder?
There are no quick fixes. The best approach is non-diet, weight-neutral care: therapy focused on intuitive eating, body acceptance, and emotional regulation. Medications like semaglutide (Wegovy) or liraglutide (Saxenda) are sometimes used for obesity, but they also carry risks for people with eating disorders and require mental health screening first. The real alternative isn’t another pill-it’s support, patience, and professional guidance.