Pinning this to the Results megathread. This is exactly the kind of detailed, honest reporting we need more of.

— would you be willing to do a follow-up post at 18 months? We have very few long-term data logs with DEXA on the forum.

Absolutely, I'll post again at 18 months. Planning another DEXA at month 16 so I'll have fresh scan data by then.

I'm 3 weeks in at 289 and feeling discouraged because I've only lost 4 lbs.

4 lbs in 3 weeks at 0.25 mg is exactly on track. Many people don't see significant appetite suppression until 0.5 mg or higher. The first month is really just about tolerability. Trust the process.

Excellent data. One thing I want to flag for the thread — the bone mineral density change from 7.2 to 7.0 lbs is worth monitoring. It's a small decline and within normal variance, but with significant weight loss you want to make sure you're getting adequate calcium (1,000-1,200mg/day) and vitamin D (2,000-4,000 IU). Weight-bearing exercise helps too, which you're now doing.

Your visceral fat reduction is genuinely remarkable. That alone has likely added years to your life expectancy. Well done.