For many overweight Americans, the battle of the bulge didn't begin with great drama. Too many fast food dinners and long work hours that squeezed out time for exercise led to gradual weight gain and, eventually, a weight problem with serious health risks.
Within weeks, some of those pudgy Americans may reach for Alli, the nation's first over-the-counter diet remedy approved by the Food and Drug Administration.
The manufacturer, GlaxoSmithKline Consumer Healthcare, has been strategically placing 1 million copies of self-help diet books that will sit on store shelves until late June, when they'll be replaced with packages of Alli as the diet pill goes on sale nationwide.
But for all of Glaxo's marketing might, Alli won't work unless consumers who buy it also commit to lifestyle changes. That means choosing healthy, low-fat diets and exercising.
The trio maximizes weight loss: For every 10 pounds the overweight consumers would lose, adding Alli would increase that weight loss to 15 pounds. Alli alone won't do the job.
Ruth Tenofsky has already learned that lesson. The Jamaica Plain woman is working on losing an extra 10 pounds, on top of the 35 she's already shed.
Tenofsky knows exactly how she put on that extra weight. After her son moved out of the house, Tenofsky, a real estate broker, and her husband frequently went out for dinner.
It didn't stop there. "I am a grazer by nature," she said. "I sort of figure if you eat it standing up, it doesn't count. I would eat a cracker. Only it wouldn't be a cracker, it would be the whole box."
A few months after those excess pounds dampened her enthusiasm for a vacation trip to the beach, she resolved to take action last fall with the assistance of Dr. Caroline Apovian , director of the Nutrition and Weight Management Center at Boston Medical Center.
"I said, 'I've got to learn to eat properly,' " recalled the 62-year-old. "Like a lot of women my age, we lose sense of what a portion size is."
She lost the weight through a combination of improved diet, a commitment to exercise, and Xenical -- a prescription version of the drug that will be sold over the counter, at a lower dose, as Alli.
But Tenofsky does not credit swallowing a magic bullet for her magical transformation.
She's on the treadmill two or three times a week and takes Pilates another two or three times a week. She's banished crackers and pretzels and replaced them with fresh fruit. She and her husband still eat out, but "grilled, steamed, broiled, sauce on the side" has become her mantra.
GlaxoSmithKline's gamble is that over-the-counter users will be as committed to lifestyle changes as Tenofsky is.
At 60 cents per pill, Alli helps burn 150 to 200 calories, about what you'd down in a quarter-cup of Ben & Jerry's New York Super Fudge Chunk ice cream. It's also the amount of calories one could burn for free, by taking a brisk walk for 15 minutes and gardening for another 15 minutes.
People will take Alli three times a day, with meals that contain about 15 grams of fat. (That's the amount of fat in two tablespoons of peanut butter.) Alli works by blocking fat absorption. Eat too much fat, however, and the drug's dreadful side effects can kick in: oily gas and such sudden, uncontrolled bowel movements. Glaxo suggests that new Alli users wear dark apparel and have a change of clothes ready.
Still, Edward Jones analyst Linda Bannister projects that Alli will carve out $200 million in annual sales, because Americans are hyper weight-conscious.
"It's not for everyone," Apovian cautions. "It is certainly not for the person who wants to lose 10 pounds tomorrow -- no way."
Diedtra Henderson can be reached at firstname.lastname@example.org.