Weight loss

Please be kind, this is a sensitive subject for me and I'm struggling.

Hi, I'm an American citizen living in the Netherlands having moved here to live with my husband. I am obese and trying to lose weight - I have lost about 50lbs with lifestyle changes since 2022, and an additional 10lbs after starting Metformin for my PCOS. I currently have a BMI of 35.5. The Metformin was great for about a year because it limited my appetite, but that side effect has worn off over the last 3-4 months or so.

I have a history of disordered eating and counting calories triggers this for me, so that's difficult for me to do safely without relapsing.

I take many medications for my Bipolar 2, insomnia, and anxiety (among others) and they have contributed to a lack of weight loss recently - my food noise has gotten really bad and if there's food in the house it's really difficult for me to not eat it/think about it constantly. I'm hungry a lot of the time. I walk about an hour every other day, and sometimes walk for a few hours (usually once a week).

I do not currently have a scale, but over the last 3-4 months my pants have been fitting tighter and I think I've gained 5-10lbs due to my appetite returning.

I have an appointment to discuss weight loss options with my GP here in NL next week, but I'm really concerned she's going to say "eat less, exercise more" as my only option, when that isn't something that's been working for me recently.

I understand that medications are not usually prescribed to help people with weight loss unless they have a BMI of over 40, but due to my comorbidities (PCOS, bipolar, anxiety, ADHD, insomnia, severe sleep apnea) I think I may qualify with a BMI of 35.5.

If she does say tough luck pal, I'm going to go through another company and just pay out of pocket for semaglutide or a similar drug, but I'm wondering what you guys think my chances of getting help from my GP is? Is there anything I can say to raise my chances of getting chemical help?

Again, please be nice. I've spent my whole life struggling with my weight and it's incredibly difficult to ask for help with it.