[petesergeant]

> With these drugs, is there any mechanism at work beyond "patients have a lower appetite and eat less food"?

Those are definitely the key routes, but I suspect from my experience (and so the do the drug companies!) that there's some kind of mediation of reward system going on there too. Simply put: I no longer get a massive dopamine hit from sugary food. A candy bar still tastes great, but I don't immediately want to eat another one like I used to, even if I'm genuinely hungry. My addictive response to food is gone.

My favourite foods still taste great, I just no longer have to expend all of my energy in not having three portions.

> Can the same effect be replicated by eating a higher fiber and higher fat diet with more whole foods to feel full longer and slow gastric emptying?

No. Like many people who've been on a perpetual diet, I have tried -- at length -- virtually every style of eating known to man. The food noise always comes back. Even before I started, I was eating very healthily as a base-line, mostly vegetables, mostly vegan, mostly whole foods, tracking my fiber to make sure it was high. But I've also tried and sustained for many months keto, paleo, "slow carb", all sorts.