The problem, as it is for a shitload of women, is that the delta between "Minimum amount of calories needed to not be somewhat malnourished" and "calories you eat now without losing weight" is sometimes zero. Short women working desk jobs are fucked

I was with a girl that barely ate, and couldn't get her weight down for about a decade because of that. Eventually she got really excited about a local dance studio and suddenly her weight dropped like a rock. She had to exercise more, but that was miserable until she found exercise that was effective and actually clicked, then it was trivial

Meanwhile it was trivial for me to eat less, because my budget should be around 1800 calories a day, and I was eating 3000. It's easy to cut out an entire bag of doritos. It is less easy to literally starve yourself.

People seem to forget as well that when you cut calories, your body will scream bloody murder until it re-adjusts. My body was convinced I was starving while I was 50 pounds overweight and eating 2000 calories because I had previously eaten more. Your body did not evolve in an environment where that was ever the wrong thing to feel! "Please eat more or we die" is one of the most powerful biological signals.

That these medications cut that signal is entirely why they work! If people just "couldn't stop eating" then not having hunger or appetite signals wouldn't have worked either.