Dr.RaviCardio said:

Training does two things here and only one of them is on the scale.

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.

raj_cambridge 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 94 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.

PeptideChemSF said:

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

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 carlos_SATX — and this may be the naive question:

What training is actually for during a large deficit, because framing it as calorie burn sets people up to quit when the arithmetic disappoints them?

Reporting back.

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.