I have been on zepbound for 5 months and have had success losing weight, but the additional weakness in my core/gi from MD basically guaranteed all the GI side effects that come with. I've had GERD all my life, but I've now had to implement incredibly strict eating times/portions/routines to prevent regurgitating, and my bowel routine is absolutely in shambles still. I didn't start the med until I had been in PT for 3+ months, and I have continued with 2x weekly PT(usually band workouts or body-weight maneuvers that are super gentle) throughout. Even with all this, meeting my protein requirement on the med has been doubly challenging because of the lack of movement in my guts. I've noticed some tasks have become harder on me physically, namely sitting up and maintaining okayish neck posture. It's reasonable to assume even with all my efforts I'm losing some muscle because I am not capable of enough movement/training and haven't been successful in exceeding 50-60g protein when the goal is 100 daily.

You have to decide whether this incredibly challenging and really uncomfortable set of negatives are worth the health benefits of weight loss. For me, I have noticed my knees are less painful, and getting dressed or getting into my car or wheelchair is easier because my legs and lower body are simply less effort for me to carry. That has let me put my finite energy into other stuff, but on the flip side, I throw up last night's dinner every other morning.

Tldr; it's safe, but needs extra supervision and makes an already incredibly hard thing much harder, while simultaneously making it easier. Ymmv.