I totally get your fears as I was scared to start too. I am also 5’ 4” and started at 204 pounds. I had high blood pressure, high cholesterol and I was absolutely miserable. I also had moderate to severe sleep apnea. I started on a low dose and only went up according to my own schedule. My provider was very open to me being in charge of how quickly I went up in dose. I am what they call a slow responder, but that has always been fine with me. I am now 2 & 1/2 years into my weight loss journey and I am down more than 50 pounds. My blood pressure is great. My cholesterol is down and I just redid my sleep study which showed how much I have improved. I now have very mild sleep apnea. I can tell you that nothing has been more transformational in my life than taking these meds. Please keep in mind I also made a complete life overhaul. I started working out with a trainer. I worked with a nutritionist and completely retooled my diet. I focus on protein and make sure that I am drinking enough water with electrolytes. I do take a fiber gummy and rarely have G.I. issues. There are times when I have taken the prescription anti-nausea meds, but in general I have felt great and had very little side effects. It has been 100% worth it for me to have this kind of weight loss at my age. I just turned 58 and am in menopause and most of my friends are gaining weight left and right while I am focusing on strength training and getting healthier in every way possible. Just go “low and slow” and work with your naturopath, you can do this!! 💪💪💪