mike.trainer_LA said:

Body image adjustment with mental health: I've lost 92 lbs but when I look in the mirror, I still see my old self sometimes.

I read this differently from mike.trainer_LA, on substance rather than tone. I would be careful about how confidently the flatness reports get attributed. Rapid weight loss, a large deficit and disrupted sleep produce low mood on their own, and separating that from a drug effect is genuinely hard.

roxy_nash said:

My mood has been flatter since about month four and I genuinely cannot work out whether that is the drug, the deficit, or the fact that I no longer…

roxy_nash said:

...mental health should only be used alongside therapy...

I'd say therapy should be AVAILABLE to all GLP-1 patients, but requiring it as a precondition for treatment would create an access barrier.

Not everyone can afford therapy. Not everyone needs it. Some people do just fine with medication + lifestyle changes. But for those with emotional eating, body image issues, or disordered eating history, therapy is extremely valuable.

My recommendation: make mental health screening part of the initial assessment, offer therapy as a recommended adjunct, but don't gatekeep medication access behind it.

anders_CPH said:

I would be careful about how confidently the flatness reports get attributed.

Mood changes on mental health: I want to be transparent — I went through a rough patch emotionally around month 2. Not depression exactly, but a weird flatness. Food was my main coping mechanism and without that, I had to develop new ones.

Therapy has been essential. I'd strongly recommend anyone starting GLP-1 therapy also invest in mental health support. The physical transformation is only half the journey.

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

How would you tell the difference between that and the alternative explanation?

Reporting back.

Follow-up — I put something in the gap where food used to be rather than waiting for the gap to close on its own. That was the part nobody told me.