How are you handling nutritional requirements? Do you take a bunch of supplements? Are you loading up on protein?
>There were major weight related health complications I was having at 34 BMI and they're not happening now.
I also experience a lot of health complications past certain weight, but I find it's more correlated to my bodyfat than BMI. Reflux and other issues I use to experience at 27 BMI @ 30%bodyfat, I start feeling at 32 BMI @20% bodyfat after building a lot of muscle. Difference between 27BMI @ 170lbs and 32BMI @200lb for me is ~30lbs. And the caloric difference between 170lb sedentary life style where my body starts acting up and 200lb 1-3x per week exercise life style where I don't is over 600 calories, which opens up a lot of dietary flexiblity in my life. Looking better is plus. But also just eating more than what I was during my obesse days and have good energy all the time. That said if I get to 205lbs all those symptoms come rushing back. I can see myself and others going on ozempic route if it's a means to nudge baseline weight below health complication effects. But hard to imagine phases of being on such big deficits.
Intuition tells me effective diet pills are excellent crutches at not building habits. Seems like recipe for yoyo pilling, which to be fair isn't unlike seasonal dietting except pills make the dietting part predictable. Gut feeling is still massively accessible diet pills is net good in terms of public health if it reduces all the conditions associated to being overweight.
IIRC, stomachs are fairly elastic, and so can expand. If one consumes/d larger volumes for an extended period of time then that stretch could perhaps become permanent (AIUI), so to actually feel full you have to consume more—which then the rest of one's body has to deal with.
It's one of the things that gastric bands can help with, and also sleeve gastrectomy.
There were major weight related health complications I was having at 34 BMI and they're not happening now. I knew how to lose weight -- meticulously track every calorie, use diet and exercise to hit targets. I had done it before , down to -10% and -25% body mass twice in the past ten years. But it never stayed that way -- I found it incredibly hard to stick to my kcal in goal or to stay at a stable lower weight. I'd eat when I was hungry, and eat enough to stay at my long term stable weight. If I ever stopped tracking every calorie in, my default sense of "full" tended towards a caloric surplus.
This drug fills exactly the gap I was struggling to fill with previous attempts at weight loss. I've felt "full" at 1500 kcal/day for months (though have had more of an appetite in the past 1-2 months) and have ended almost every day with a caloric deficit. It's a serious pharmaceutical intervention and I read the literature on GLP-1 agonists for years before starting. There were side effects, notably reflux when eating too much, "sulfur burps", and a general feeling of malaise for the day after taking a dose for the first few months.
No idea what the long term consequences of staying on this drug forever will be. Haven't noticed any other behavior changes. Not particularly interested in the appearance angle (I felt like I looked okay before and look okay now, though I've needed new clothes due to dramatic changes in waist size).
But the health stuff is serious and real and if we can make this drug cheaply available to people who discuss it carefully with a doctor there is potential for a serious chronic disorder to be addressed much more effectively than it used to be.