Dr.GutHealth said:

Mood changes on mental health: I want to be transparent — I went through a rough patch emotionally around month 2.

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. 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.

Dr.ObesityMed 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…

Body image adjustment with mental health: I've lost 58 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.

Dr.PainCLE said:

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

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

Before (281 lbs): Winded climbing stairs, chronic back pain, pre-diabetic, on 3 medications, dreaded mirrors, avoided photos, social anxiety about my weight.

After (186 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: 96 lbs. Total life gained: immeasurable. This isn't just about weight — it's about reclaiming your identity.

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

Was that from a primary source or from a summary of one?

Closing the loop on my own question.

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.