LabKate said:

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

LabKate 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.

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

How long did you give it before you decided it was working?

Dr.AddMedPHL said:

LabKate said: ...mental health should only be used alongside therapy...

Before/after narrative for mental health — one year in:

Before (286 lbs): Winded climbing stairs, chronic back pain, pre-diabetic, on 3 medications, dreaded mirrors, avoided photos, social anxiety about my weight.

After (191 lbs): Run 3 miles regularly, pain-free, A1C normal, down to 1 medication, bought a swimsuit for the first time in a decade, actually enjoy being photographed.

Total weight lost: 71 lbs. Total life gained: immeasurable. This isn't just about weight — it's about reclaiming your identity.

OP back with an update, since a thread like this is useless without one.

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.

Dr.GastroMayo said:

Before/after narrative for mental health — one year in: Before (286 lbs): Winded climbing stairs, chronic back pain, pre-diabetic, on 3 medications,…

Body image adjustment with mental health: I've lost 92 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.