This is the version of the explanation I wish somebody had given me, written down before I forget what confused me. It is about mood and mental health, and it is deliberately narrow — everything I am not confident about is marked as such.
What is actually established
The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously. On the positive side: reduced anxiety around food, better self-image, more confidence. On the difficult side: grief for the years lost, identity disruption, relationships built around eating, and the loss of food as a coping mechanism with nothing put in its place. Rarer but real: anhedonia and emotional flatness. Regulators have started asking for validated patient-reported outcomes in this class; the existing data gap is not evidence of absence.
The condition it depends on
For anyone with an eating-disorder history this needs a clinician in the loop rather than a forum. The same drug can be therapeutic in binge-eating disorder and actively harmful in a restrictive disorder.
What I am not sure about
What I actually want to know is how people separated a drug effect from the ordinary consequences of a large deficit and disrupted sleep, because I cannot. I have searched first, so if this is covered somewhere point me at it and I will read it.
— LabKate · corrections welcome and will be edited into this post with credit