GLP-1 and addiction pathways — anyone have experience?

sean_dublin said:

The weight came off and the harder part started, which is not what any of the material I read had prepared me for.

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

Before (260 lbs): Winded climbing stairs, chronic back pain, pre-diabetic, on 3 medications, dreaded mirrors, avoided photos, social anxiety about my weight.

After (195 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: 90 lbs. Total life gained: immeasurable. This isn't just about weight — it's about reclaiming your identity.

Dr.KarenChen said:

Before/after narrative for mental health — one year in: Before (260 lbs): Winded climbing stairs, chronic back pain, pre-diabetic, on 3 medications,…

Dr.KarenChen 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.

sean_dublin 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. The detail I would add is minor and it is already implied above.

Clinical perspective, offered as context rather than as advice.

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.