The social aspect really resonates. I've lost 40 lbs in 5 months and my best friend (who's also overweight) has become noticeably cold toward me. She hasn't said anything directly but she's stopped suggesting we do things together and her texts are shorter. It hurts.

This is an excellent and balanced post. The good AND bad format is really helpful for people considering treatment.

For anyone struggling with the social/emotional side, we have a dedicated thread in the Support section for mental health and relationship changes during weight loss. You're not alone in these experiences, and they're just as valid as the lab numbers.

Thank you all for the supportive responses. And to be clear — I'm in a much better place mentally now than I was at months 4-6 when all the side effects were peaking simultaneously. The GI stuff, the hair, the social weirdness — it was overwhelming. Now at month 12 I've found a new equilibrium.

If I could go back and give myself advice on day 1:

1. Start lifting immediately. Don't wait.
2. Get a therapist who understands weight loss and body image. Start before you need them.
3. Track your protein obsessively. It's the single most important nutritional variable.
4. Take progress photos. You WILL forget how far you've come.
5. The first 3 months of side effects are not representative of the long-term experience. It gets better.