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Side effects and risks of lipase inhibitors The most common side effects of orlistat are gastrointestinal, including: Loose, greasy stools Diarrhea Gas (flatulence) Leakage of feces (poop) onto underwear or clothes Abdominal pain Tears in the anus Because orlistat works by blocking fat absorption and removing excess fat as waste, these side effects may be more common after eating high-fat foods or meals