VA Weight Loss

I've hit a wall with weight loss and last night was the figurative straw that broke the camel's back--I sat on the edge of my bed and a slat on the box spring broke. Yup, what I'm doing isn't working.

I have a BMI of 38--Class II obesity. My weight gain is primarily associated with pain/BH meds that I don't really have any alternatives to. I was running marathons before I started taking these meds, but now it hurts my knees just to walk because of all the extra pounds. This is not an "abs are built in the kitchen" problem.

My VA PCM says the VA has done everything they can and I should look elsewhere for continued treatment. I've tried: - The MOVE program (I know how to eat and how to be physically active. That's not the problem) - An appetite suppressant (bupropion/naltrexone--made me cranky and put me in a brain fog) - I declined a calorie/fat absorber (orlistat--taking it would exacerbate my IBS and excessive calorie/fat intake isn't the issue) - "Shortages" limit GLP-1 agonists to diabetes patients only.

And thats it. The FDA has the following medicines approved for weight loss: - Phentermine (short-term use) - Diethylpropion (short-term use) - Orlistat - Phentermine-topiramte - Bupropion-naltrexone - Liraglutide - Gelesis - Semaglutide (Wegovy) - Tirzepatide (Zepbound) - Gelesis100 - Metformin (off-label) - Topiramate (off-label)

Even ignoring Wegovy/Zepbound, there are clearly still medication options but my care team/weight loss clinic say they "don't do them".

So, has anyone recieved other non-surgical treatment from the VA or have any tips for making more progress? TIA.