Grief over lost years — 6 month update

mel_PDX said:

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

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.

mel_PDX said:

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

Pushing back on mel_PDX 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.

Dr.LipidDallas said:

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

Dr.LipidDallas 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.ObesityLA said:

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

Adding a me-too, because a thread of one person's experience is not much use.