NurseKim_ATL said:

Body image adjustment with mental health: I've lost 56 lbs but when I look in the mirror, I still see my old self sometimes.

Pushing back on NurseKim_ATL 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.

InsuranceTom said:

My mood has been flatter since about month four and I genuinely cannot work out whether that is the drug, the deficit, or the fact that I no longer…

InsuranceTom 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.

Dr.AddMedPHL said:

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

When to call your doctor about mental health side effects — a reference I wish I'd had:

Call immediately:

• Severe abdominal pain (could be pancreatitis)
• Vision changes (thyroid concern)
• Lump in neck (thyroid nodule)
• Severe vomiting/can't keep fluids down for 24h+

Schedule an appointment:

• Persistent nausea beyond 4 weeks
• Significant hair loss
• Mood changes or depression
• Gallbladder symptoms (RUQ pain after eating)

One thing that is still open after newstart_MO’s answer:

What would you measure differently if you were starting again?

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.