From the other side of the consultation, briefly.

One year anniversary on mental health — reflections:

What I wish I'd known: the side effects are temporary, the benefits compound over time, protein is more important than I thought, and the mental health aspect needs as much attention as the physical.

What surprised me: how much my relationship with food changed, the cascade of health improvements beyond weight, and how supportive this community is.

What I'd do differently: start therapy earlier, prioritize resistance training from day 1, and stop comparing my progress to others. Everyone's journey is unique.

One thing that is still open after RegAffairsDC’s answer:

Did your prescriber agree with that reading, and if not what was their objection?

SarahChen_PharmD said:

One year anniversary on mental health — reflections: What I wish I'd known: the side effects are temporary, the benefits compound over time, protein…

Therapy insights from my mental health journey: my therapist introduced me to the concept of "identity updating" — the psychological work of becoming a new version of yourself.

Key realizations: I used food to manage emotions, I had internalized fatphobia that I'm still unpacking, my social identity was partly built around being "the big guy/girl," and learning to accept compliments is surprisingly hard when you've been invisible for years.

Physical transformation without emotional processing is unstable. Do both.

SarahChen_PharmD said:

One year anniversary on mental health — reflections: What I wish I'd known: the side effects are temporary, the benefits compound over time, protein…

That is right, and it stops being right at the edges. The general case is well behaved; the interesting cases in this thread are all at the boundary where the general case breaks.

Moderator note: a couple of off-topic posts removed.