JakeSmashed95 said:

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

Body image adjustment with mental health: I've lost 80 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.

A narrower follow-up, since the general answer is now clear:

Was that from a primary source or from a summary of one?

NicoleRaleigh said:

Body image adjustment with mental health: I've lost 80 lbs but when I look in the mirror, I still see my old self sometimes.

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

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.

Closing the loop on my own question.

Update: I got the sleep and the intake sorted before deciding it was the drug, and most of the flatness went with them. Not all of it, and I am watching the rest.

Dr.GutHealth said:

Anxiety increase on mental health: counterintuitive, but losing weight rapidly triggered anxiety for me.

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.