Answering the narrow version, because the broad one does not have a single answer. Training does two things here and only one of them is on the scale. It protects lean mass — which is the reason to do it — and it contributes modestly to the deficit, which is the reason people start and then quit when the arithmetic disappoints them. In a deep deficit, resistance work is the priority and high-volume cardio competes with recovery.

Dr.RaviCardio said:

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

Agreed, with the caveat that "exercise" for someone with mobility limitations is a different set of options, and the standard advice is written as though everyone can walk for an hour.

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.

Same pattern here, and in the same order.

Clinical perspective, offered as context rather than as advice.

raj_cambridge 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.