From the other side of the consultation, briefly.

Body image adjustment with mental health: I've lost 76 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.

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

Did your prescriber agree with that reading, and if not what was their objection?

sean_dublin said:

Body image adjustment with mental health: I've lost 76 lbs but when I look in the mirror, I still see my old self sometimes.

Recovering from an eating disorder and using mental health: this is a complex situation and I want to be transparent about it.

I have a history of binge eating disorder. My psychiatrist, therapist, and prescribing doctor all collaborate on my care. The GLP-1 agonist has actually been therapeutic — it removes the biological urgency of binge impulses without relying on restriction.

This is NOT appropriate for all ED patients. Anorexia, bulimia, and restrictive EDs require different approaches. But for BED specifically, the evidence and my personal experience are positive. Always involve your mental health team.

sean_dublin said:

Body image adjustment with mental health: I've lost 76 lbs but when I look in the mirror, I still see my old self sometimes.

Agreed, with the usual condition: that holds for the average and this board is a collection of individuals. A population claim and a personal prediction are different things and get quoted interchangeably.

That is the short version; the long version is somebody else's post.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful. Tagging this one for the weekly digest.