TomTeleRx said:

The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously.

TomTeleRx 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.

TomTeleRx said:

The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously.

This is where I part company with the consensus forming above. 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.

Dr.RaviCardio said:

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

Body image adjustment with mental health: I've lost 83 lbs but when I look in the mirror, I still see my old self sometimes. "Phantom fat" is a real phenomenon.

My therapist specializes in body image issues with weight loss patients. She says it can take 12-18 months for your brain's body map to update. In the meantime: take progress photos (your eyes lie but cameras don't), try on old clothes, and be patient with yourself.

DataDave said:

TomTeleRx said: ...mental health should only be used alongside therapy...

Second this. Nothing to add that would improve it.