Clinical perspective, offered as context rather than as advice.

Recovering from an eating disorder and using mental health: this is a complex situation and I want to be transparent about it.

I have a history of binge eating disorder. My psychiatrist, therapist, and prescribing doctor all collaborate on my care. The GLP-1 agonist has actually been therapeutic — it removes the biological urgency of binge impulses without relying on restriction.

This is NOT appropriate for all ED patients. Anorexia, bulimia, and restrictive EDs require different approaches. But for BED specifically, the evidence and my personal experience are positive. Always involve your mental health team.

dan_philly said:

Therapy insights from my mental health journey: my therapist introduced me to the concept of "identity updating" — the psychological work of becoming…

dan_philly 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.

dan_philly said:

Therapy insights from my mental health journey: my therapist introduced me to the concept of "identity updating" — the psychological work of becoming…

Bookmarking. The distinction being drawn above is the one nobody else makes.

From the other side of the consultation, briefly. It is worth asking what the claim would look like if it were false. If nothing would look different, it is not a claim about the world and no amount of discussion will settle it.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. Carry on.