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Timeline: when patients notice changes The first changes most patients report are sleep-related, typically improved sleep depth and morning energy levels, appearing within weeks two to three of the first cycle

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Warning signs you should bring up to a healthcare practitioner include: Not experiencing any hunger and fullness cues at all Persistent nausea, vomiting, or diarrhea beyond the initial titration period Rapid weight loss (more than 1% of body weight per week after the first four weeks) Cold intolerance, hair loss, or dry skin, which can be signs of undernutrition Eating fewer than two meals per day, or skipping meals regularly Consciously using medication to avoid food Eating only to take medication, or avoiding medication days to eat more freely Feeling excessively preoccupied with food or the way your body looks Anxiety about eating Guilt after eating Black and white restrictive thinking about food (labeling foods as good or bad) Rigid rules about timing, amount, or type of foods youll eat Fear of eating specific foods that you previously enjoyed Avoidance of social eating situations Secrecy: hiding your medication or eating habits from friends and family, feeling hesitant to discuss side effects with your practitioner, or lying to get access to the medication If you notice any of these symptoms, its important to check in with your healthcare provider and/or a mental health provider

doi: 10.1016/j.bbadis.2013.01.008 130 JacobsenLVFlintAOlsenAKIngwersenSH