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Semaglutide typically produces 1522% weight loss on its own, which often exceeds orlistat's 510% reduction

A meta-analysis study showed that for L-carnitine to have significant effects on FBG levels in patients with diabetes, 2 grams/day should be taken as a supplement for at least 36 weeks, also it is estimated that 2 g of L-carnitine per day is needed for at least 106 weeks to have a significant effect on HbA1c levels (87)

I think that it would be very unpopular once you have patients on these medicines to try to take that away.

Though there may be some preliminary evidence that the medications offer such benefits, there is generally a lack of good evidence to support their use