Dr.KarenChen said:

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

Pushing back on Dr.KarenChen here. 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.PathRoch said:

The weight came off and the harder part started, which is not what any of the material I read had prepared me for.

Body image adjustment with mental health: I've lost 88 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.

Dr.PainCLE said:

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

Anxiety increase on mental health: counterintuitive, but losing weight rapidly triggered anxiety for me. Change — even positive change — is stressful. I was anxious about regaining weight.

This is more common than people admit. A therapist who specializes in weight management has been invaluable. Don't neglect the mental health side of this journey.

Following on from PeptideChemSF — and this may be the naive question:

What would you measure differently if you were starting again?

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.