andrew_nyc said:

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

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.

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

What did you change at the same time, and can you separate the two now?

Dr.PulmRoch said:

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

Body image adjustment with mental health: I've lost 66 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.

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.

PharmD_Rodriguez said:

Body image adjustment with mental health: I've lost 66 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 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.