Finally can comment a bit on this personally. I have been overweight since shortly after high school. Worked at an ice cream shop for my first job, and learned a LOT of bad eating habits as a result. At my upper limit, I reached 275lbs at 6'3". Because of my build, I didn't look huge. Last year was the final straw for me. Almost 30, no partner, fat, crappy car, I finally had enough. Had to make major changes in my life, and one of those was for weight. Sat down with my doctor and a dietician, who helped me work out a gameplan. Initially we started with just diet and exercise. After a couple of months, I was down a total of five pounds. I kept a food and exercise journal, provided this to the ones helping, and found that I was doing what I needed to for the most part. Occasional slip-ups, but meals were always well-tracked, snacking was within reason, and I wasn't going absurd. I would almost always target a calorie limit of 1,500. Real cooking, balanced meals, the works. Exercising was never an issue, as I am usually relatively active.
Since the mental changes were done for the most part, we ended up trying something a bit different: medication. I didn't want to move towards medication for this, but my doctor wanted to at least try. I started using a medication called Wegovy, which is still relatively new. I was lucky enough to get into the program before the company discontinued the support systems (supply chain issues). This was the help I needed, big time. In less than 6 months, I have gotten down to 210lbs. It's like someone flipped a switch and said "OK, you are eating right, now let's drop some weight". As long as I don't plateau any harder than I currently am, I should be able to reach under 200 within the next month or so. From what I was told by my doctor, insulin resistance played a major role in my weight. Wegovy allowed me to process food properly, reduce intake further (while remaining safe), and really push me further than I ever could have by myself. It isn't magic, though. Side effects have been pretty moderate, with the majority of them being gastrointestinal. It is also an injection, which will sway a lot of people away from it. It isn't unmanageable for me, but I definitely see it being impossible to handle depending on the person. Norvo, the company behind it, states this should be a constant medication for management, but my doctor and I are hoping to avoid this. My doctor seems to believe we can pivot to a different, less obtrusive medication for my insulin resistance, and hopefully allow me to maintain a healthy weight.
I still hate that I needed medication to get where I am now, but I also know that, at least for me, I needed help. All in all, I am in a better place than I was before starting everything, and as long as I am not an idiot going further, it should be in the past. Fingers crossed.