For nine months, I did not stand on a scale. I did not look at myself in a full-length mirror. I told myself I was busy. The truth was that I was frightened of what I might see.
I had reached my target weight, and my BMI had fallen below the range my prescriber and I intended. We discussed reducing my dose. Clinically, it was reasonable. Psychologically, it felt like a cliff edge. Would the food noise return? Would the lower dose still be enough? I could no longer remember clearly what that dose had felt like.
At first, I avoided my changing body. My clothes hung loosely, and I could fit into some of my daughter’s clothes, but I could not make myself look properly. Had I lost enough, or too much? Had I developed the so-called “Ozempic face” or body people discussed?
Then avoidance became checking. I examined my face, cheekbones, jawline, arms, neck, and rib cage, looking for anything that seemed more prominent than it had the day before. The checking settled the question for a few minutes. Then it returned.
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Research on repeated critical body checking has linked it with poorer body satisfaction and other negative emotional and cognitive outcomes. That was how it felt for me. The checking did not settle the fear. It gave the fear another task.
My body had changed. My understanding of myself had not caught up. The food noise had reduced, but the space it left did not remain empty. It was replaced by an identity crisis.
The questions begin before the day does
Before I leave for work, the questions have often already started. How strong do I feel? How bad is the brain fog? Will I weigh myself again? Will I stand in front of the mirror and check whether any part of me looks bonier than it did yesterday?
Then there is food. I pack lunch and snacks because I need them during a shift, yet much of that food sometimes comes home half-full or untouched. The person packing it and the body expected to eat it later do not always seem to have the same information.
Some mornings, I have to talk myself through the door, trying to bring a tired body and a foggy brain into alignment so that I can function as a nurse, colleague, and mother. And underneath all of it sits the harder question: Who am I today?
I expected weight loss to mean feeling better and having more energy for my children and their activities. Some benefits came, but fatigue remained. On some days, the brain fog was worse, particularly when eating and drinking had been difficult.
When your changing body reaches your family
Most of my family and closest friends were overseas, and I had not shared my weight loss publicly. Even so, a cousin saw a photograph and gently told me not to lose any more. My mother said the same, with worry in her voice. Their concern was loving, but it intensified my own question: Had I gone too far?
The most difficult moment came when one of my children began comparing her eating and body with mine. She started eating less after noticing that my body was becoming smaller.
I wondered what she was learning from watching me. Was my treatment unintentionally teaching her that eating less and becoming thinner were things to pursue?
I had to explain why I used the injections, how they affected appetite and weight, and why stopping treatment could allow hunger and weight to return. No prescription had prepared me for that conversation.
Fear can move the definition of enough
Even after being told that my BMI was lower than intended, I caught myself wondering whether I should lose a little more before reducing the dose. I imagined creating a buffer so that, if I regained weight, I would have room before crossing what I had begun to regard as the danger line. That thought showed me how fear had moved the goalposts.
The STEP 1 extension found that participants who stopped semaglutide 2.4 mg regained, on average, about two-thirds of their prior treatment-associated weight loss during the following year. That helps explain why fear of regain is understandable. Knowing the biology, however, does not remove the psychological burden of anticipating it.
A 2026 JAMA Network Open qualitative study of 30 glucagon-like peptide-1 (GLP-1) users found that reduced psychological hunger, food noise, or appetite was one of the dominant patient-reported experiences. Mine reduced as well. But I still did not know which version of my body belonged to my identity as a nurse, mother, worker, and patient.
I do not use “identity crisis” as a psychiatric diagnosis. I use it to describe the distance between the body other people can see and the self still trying to understand what has happened.
The follow-up questions clinicians need to ask
Clinical follow-up often concentrates on weight, adverse effects, and laboratory results. We should also ask whether treatment has changed how a person feels about food, their body, or being seen by others; whether they are avoiding mirrors or checking repeatedly; whether they can eat and drink enough to function; and what they fear will happen if treatment changes or stops.
I spent months unable to look at my body and the months afterward unable to stop looking.
My body had been treated. My fear had not.
If we measure only weight, we will continue to miss the person standing in front of the mirror, or the person who still cannot make herself look. Better GLP-1 care must treat the biology without abandoning the self that has to live with the change.
This essay is cited in the KevinMD record on GLP-1 drugs.
Patience C. Ennis is a registered nurse, author, Results Coach, glucagon-like peptide-1 (GLP-1) user, and the founder of Body Compass, an education and navigation platform for people living with, considering, or moving beyond GLP-1 treatment. A graduate of King’s College London, she draws on more than three decades of clinical experience across emergency, community, palliative, and aged care, bringing together clinical knowledge, lived experience, and patient education to address the questions that often sit beyond the prescription.
Through Body Compass, she develops evidence-informed resources, books, practical tools, news updates, and non-clinical coaching support designed to help people understand changing appetite, side effects, strength, food noise, treatment adaptation, maintenance, and stopping. Her work is grounded in clarity, dignity, and honest interpretation of evidence, without hype, shame, or false certainty. Her aim is not to tell people what to decide, but to help them understand the terrain, ask better questions, and navigate metabolic health with greater confidence in everyday life and care.
She is the author of When GLP-1 Feels Different: Plateau, Food Noise, Adaptation and the Fear of “Resistance” (2026), available on Amazon and through Body Compass. Her other titles include Living Well on GLP-1 Medication: A Practical Guide to Everyday Life Beyond the Prescription, The Body Compass 30-Day Navigation Diary: A Reflective Daily Companion for GLP-1 Treatment, and The 30-Day GLP-1 Navigation Companion: Observation, Reflection, Preparation, Navigation.
She shares updates on LinkedIn, Facebook, the Body Compass Facebook page, Instagram, X, TikTok, and YouTube.
