Obesity Treatment Bydgoszcz

The Polish Society for the Treatment of Obesity (PTLO) describes obesity in its 2024 recommendations as a chronic disease, classified as E66 in ICD-10. It has many causes and can recur. Leptin signals energy stores to the brain, while ghrelin contributes to hunger. Changes in appetite regulation and energy expenditure after weight loss can make a lower weight difficult to maintain, so long-term support is often needed.

We tailor the treatment plan and dosing to health, medication and response. The doctor assesses suitability for medication and test results. The programme also includes two online consultations with a psychologist. We provide the whole treatment online, in a programme lasting 6 months.

How does excess body fat build up?

The essence of obesity is an excess of fat tissue that harms health. This excess builds up gradually: over months and years the body takes in more energy from food than it uses and stores the surplus as fat. First the fat cells grow in volume, and when the surplus lasts longer, their number increases too. Fat collects under the skin and around the abdominal organs, and visceral fat, which surrounds these organs, is the most harmful. That is why we measure waist circumference as well as body weight.

Comparisons of identical and non-identical twins show that genes explain 40 to 70 percent of the differences in body weight between people. Obesity in parents or siblings therefore raises the risk of the disease. An inherited tendency leads to weight gain with desk-based work, commuting by car and high-calorie food available at every turn. Too little sleep, long-term stress, shift work, pregnancy, menopause and quitting smoking also speed up weight gain. In some patients medicines or diseases, such as hypothyroidism or Cushing's syndrome, add to weight gain, so before starting treatment we check the list of medicines the patient takes.

How does obesity lead to complications?

Fat tissue also acts as an endocrine organ. Insulin resistance, changes in sex hormones, chronic inflammation and changes in the gut microbiota may contribute to complications, including some tumours. This relationship is complex. PTLO cites an estimate attributing around 4 to 8% of cancers to obesity; this is not an individual's chance of developing cancer. We explain the evidence in the oncology section.

The scales alone are not enough for a diagnosis. We work out the BMI at the appointment, body weight in kilograms divided by height in metres squared, so a man 178 cm tall who weighs 108 kg has a BMI of 34. The thresholds set by the World Health Organization (WHO) and adopted by the PTLO are the same for women and men. Overweight begins at 25, class I obesity at 30, class II at 35 and class III at 40. The same index fails in people with a lot of muscle, and it says nothing about where the fat sits.

We also measure the waist midway between the lowest rib and the top of the hip bone, after a gentle exhalation. The International Diabetes Federation's thresholds for abdominal obesity in people of European ancestry are 94 cm for men and 80 cm for women. Visceral fat around the abdominal organs is associated with greater metabolic risk, so waist measurement adds information to BMI. We ask when weight gain began, about previous weight loss and subsequent regain, snoring, daytime sleepiness, alcohol, shift work and previous tests.

When can obesity medication be considered?

For semaglutide, liraglutide, tirzepatide and Mysimba, BMI ≥30 meets the weight criterion for considering medication. At BMI ≥27 and below 30, an appropriate weight-related condition is also needed, such as hypertension, abnormal blood lipids or type 2 diabetes. Health and contraindications must still be assessed. Xenical has separate criteria: BMI ≥30, or >28 with associated risk factors. Below BMI 27 you can seek advice, but the standard weight-management indications for these products are not met. Insulin resistance is not the same as prediabetes and does not automatically establish eligibility.

Age affects medicine choice. Saxenda is not recommended from age 75, and Mysimba above 75; Mysimba also requires caution above 65. Experience with Wegovy and Mounjaro from age 85 is limited. The doctor considers physical function, nutrition and other conditions.

The obesity treatment programme lasts six months, takes place online and costs PLN 1,799. The patient buys the medicine separately at a pharmacy with an e-prescription. Before starting, the patient has blood tests and measures weight, waist circumference and blood pressure at home. The doctor reviews the history and results, then decides whether the patient can be treated in the programme. The price includes two 30-minute doctor consultations, two 40-50-minute online consultations with a psychologist and five medical reviews of app data without a call. The patient books the video consultations in the Nasz Gabinet app. The dates of the later consultations depend on the date of the initial consultation.

The price also includes an AI assistant and monitoring of body weight and treatment progress.

Between consultations, the patient logs weight in the app every week and body measurements every month. The patient takes a photo of the pen with the used needle after each injection. The medical team looks at the photo. The doctor knows these results before the check-up begins. Nutrition and activity to protect muscle are planned alongside medication. Effectiveness is assessed according to the particular product.

PTLO recommends treating obesity for a year or longer, and even a year of treatment does not mean medication must stop. After the programme, the patient can therefore buy a continuation package: 3 months for PLN 350. In it, the doctor reviews the results every month and issues an e-prescription; the package does not include video consultations.

How do we plan safe treatment when cancer is suspected or diagnosed?

• During chemotherapy, radiotherapy or endocrine therapy, we agree the obesity treatment plan with the oncologist. After cancer treatment, nutritional status and ongoing therapy still matter; we also ask for the treating oncologist's opinion.
• Unintentional weight loss is not treated as a successful diet. We first investigate its cause and establish a safe plan.
• Screening should not wait until weight loss is achieved. Before colonoscopy or another procedure under general anaesthesia or deep sedation, tell the team about your medicine; they decide on preparation and any changes to dosing.

Before medication, tests commonly considered include fasting glucose, HbA1c, a lipid profile, creatinine with eGFR, TSH, ALT and AST, uric acid and a blood count. The doctor selects the tests. HbA1c reflects average glucose over roughly 2-3 months and helps assess glucose regulation alongside other results. TSH helps assess thyroid function; ALT and AST may indicate a need for liver investigation but do not by themselves diagnose fatty liver. Kidney function affects medicine choice. Have existing results ready before the consultation so the doctor can assess whether they remain relevant or need repeating. Missing tests can be done near home.

We review medicines and supplements, ideally with packaging or photographs. Corticosteroids, insulin, sulfonylureas and some epilepsy medicines, antidepressants and antipsychotics can contribute to weight gain. Do not stop them yourself. Any necessary changes are agreed with the treating doctor. Glucose and blood pressure are monitored and doses changed when indicated. Tell the doctor if you take tamoxifen: bupropion in Mysimba can reduce its effectiveness, so medicine choice needs to be agreed with the oncologist.

When do symptoms require further investigation?

Unintentional weight loss, blood in stools or urine, persistent changes in bowel habits, difficulty swallowing and concerning abdominal pain need prompt assessment. Tests depend on symptoms and possible causes. In men and postmenopausal women, iron-deficiency anaemia requires investigation, including for gastrointestinal disease. Iron deficiency itself needs confirmation with appropriate tests. Investigation may include gastroscopy, colonoscopy or other tests; a negative stool test does not replace medical assessment. Obesity care is then adapted to the diagnosis.

In 2016 the International Agency for Research on Cancer (IARC), part of WHO, judged the evidence linking excess body fat to thirteen tumour sites or types sufficient. These include the colon and rectum, oesophageal adenocarcinoma, gastric cardia, liver, gallbladder, pancreas, kidney, ovary, endometrium, postmenopausal breast and thyroid, plus meningioma and multiple myeloma. Eight were additions to the earlier assessment. Not all these tumours are malignant: some meningiomas are benign. Obesity is an important risk factor that can be addressed, but does not mean everyone affected will develop cancer.

How does risk change with each 5-unit increase in BMI?

PTLO summarises meta-analyses associating each 5 kg/m² increase in BMI with around 30-60% higher risk of endometrial cancer, oesophageal adenocarcinoma and kidney cancer, and around 13-18% higher risk of colorectal, pancreatic and postmenopausal breast cancer. These are broad ranges of relative risk, not 13-18 extra cases per 100 people or a personal prediction. Estimates vary by study, sex and tumour site. At 178 cm tall, 5 BMI units correspond to about 16 kg. The table highlights issues to discuss at an appointment.

What links obesity and tumours?

Insulin resistance and changes in insulin and growth-factor signalling may favour cell proliferation. Aromatase in fat tissue converts androgens to oestrogens, helping explain associations with endometrial and postmenopausal breast cancer. Chronic inflammation and the gut microbiota may also play a role. Reflux, which is more common with obesity, can damage the oesophagus. These mechanisms are complex and do not mean a tumour will develop in every person with obesity.

Can losing weight reduce cancer risk?

The observational SPLENDID study compared 5,053 people who underwent bariatric surgery with 25,265 matched people who did not. Estimated cumulative incidence of obesity-associated cancer at 10 years was 2.9% versus 4.9%; cancer-related mortality was 0.8% versus 1.4%. The weight difference was about 25 kg. Median follow-up was 6.1 years. Without random allocation, this shows an association rather than proving that surgery itself prevented cancer.

A 2025 analysis of 86,632 adults with overweight or obesity found rates of 13.6 versus 16.4 cases per 1,000 person-years for 14 tumour types among GLP-1 receptor agonist users and nonusers. Person-years represent the combined time participants were followed. The set included lung cancer and was not identical to IARC's list. An uncertain signal of potentially higher kidney cancer risk needs further assessment. This was also observational; we do not offer obesity medication as a way to avoid cancer.

Can obesity medicines cause tumours?

Thyroid concerns partly originate from rodent studies in which semaglutide caused thyroid C-cell tumours. European product information describes rodents' particular sensitivity to this mechanism; relevance to humans is considered low but cannot be completely excluded. A 2025 study in six countries compared 98,147 GLP-1 receptor agonist users with nearly 2.5 million DPP-4 inhibitor users, all with type 2 diabetes. The main comparison found no increased thyroid cancer risk, but median follow-up ranged from 1.8 to 3 years, limiting long-term conclusions. TSH assesses thyroid function, not whether cancer is absent. Ultrasound is arranged when indicated, for example for a palpable nodule.

What do these findings mean for our care?

We discuss screening at the initial consultation and at check-ups. Testing depends on age, symptoms and personal and family history. Maintaining a healthy weight is part of prevention, but weight loss does not replace screening or guarantee protection from cancer. For cancer survivors, the plan is agreed with the treating team.

GLP-1 and GIP are gut hormones released after meals that help regulate insulin secretion. GLP-1 also affects appetite and stomach emptying. Semaglutide and liraglutide stimulate the GLP-1 receptor; tirzepatide acts on both GIP and GLP-1 receptors. These medicines can increase fullness and reduce appetite. The injections discussed here are given under the skin of the abdomen, thigh or upper arm: semaglutide and tirzepatide weekly, liraglutide daily.

Liraglutide starts at 0.6 mg daily, increasing by 0.6 mg at intervals of at least a week to 3 mg. Injectable Wegovy starts at 0.25 mg weekly, usually reaching 2.4 mg over 16 weeks. Tirzepatide starts at 2.5 mg weekly, rising to 5 mg after 4 weeks; further 2.5 mg increases are made at intervals of at least 4 weeks only if needed. Adult maintenance doses are 5, 10 or 15 mg. The doctor adjusts the plan for tolerability; do not change doses yourself.

How much weight did trial participants lose and how varied were the results?

In STEP 1, semaglutide 2.4 mg produced average weight loss of 14.9% at 68 weeks, versus 2.4% with placebo. In SURMOUNT-1, tirzepatide 15 mg produced 20.9% at 72 weeks, versus 3.1%. In SCALE, liraglutide 3 mg produced 8.4 kg at 56 weeks, versus 2.8 kg. Participants did not have type 2 diabetes and received dietary and activity guidance. These were separate trials, with substantial individual variation. For a starting weight of 120 kg, the first two averages correspond to about 18 and 25 kg: a calculation, not a one-year prediction for an individual.

Assessment depends on the product. Saxenda should stop if weight loss is below 5% after 12 weeks on 3 mg; Xenical should stop if weight loss is below 5% after 12 weeks from starting, and Mysimba after 16 weeks with the same threshold. Mysimba also needs annual reassessment of maintaining at least 5% loss and cardiovascular safety. This is not one common adult stopping rule in the product information for semaglutide and tirzepatide. Decisions take account of health and treatment progress.

Weight regain after stopping medication

In the STEP 1 extension, a selected subgroup regained an average of roughly two-thirds of the lost weight in the year after semaglutide and the lifestyle intervention stopped. Most metabolic benefits diminished and measurements moved towards baseline. The study does not prove that tapering prevents regain. We agree any end to medication with the patient and plan ongoing support. If weight rises again, the doctor considers restarting or changing treatment; do not independently resume the last dose. Recurrence is part of the disease, not a personal failure.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical have weight-management indications but differ in criteria and use. Our clinic selects medication licensed for obesity treatment. Off-label use requires a separate medical decision and does not establish entitlement to reimbursement. The active ingredient or pack price alone cannot determine the choice.

Why do we prescribe Wegovy rather than Ozempic?

Wegovy and Ozempic contain semaglutide but have different indications and doses; Ozempic is licensed for type 2 diabetes. Rybelsus also has a diabetes indication. Saxenda contains liraglutide up to 3 mg daily for weight management, while Victoza uses up to 1.8 mg for diabetes. Mounjaro has indications for both type 2 diabetes and weight management. Where diabetes coexists, we coordinate the whole regimen with the treating doctor.

Current Wegovy product information allows an injectable dose of 7.2 mg weekly after at least 4 weeks on 2.4 mg, if needed, in adults whose initial BMI was ≥30. Availability of a particular pack in Polish pharmacies must be checked separately. Licensed indications and reimbursement conditions are different matters.

Pharmacy prices, from orlistat to tirzepatide

As of September 2026, these five products are paid for in full when used for obesity. Cost depends on the product, dose, pack size and pharmacy. Not every medicine needs dose escalation, and cost does not necessarily rise after a few months. Compare the prescribed dose and actual number of packs needed. Generic liraglutide prices should not be presented as Saxenda prices, nor Wegovy costs up to 2.4 mg as the cost of 7.2 mg.

When do we consider Mysimba or Xenical?

Mysimba is taken as tablets and Xenical as 120 mg hard capsules. Mysimba combines naltrexone and bupropion, affecting appetite regulation and reward pathways. In COR-I, weight loss at 56 weeks was 6.1% versus 1.3% with placebo, alongside lifestyle changes. Choice also depends on conditions and interactions. It is not used, for example, with uncontrolled hypertension, epilepsy, bipolar disorder, a history of bulimia or anorexia, opioid treatment or acute alcohol withdrawal. Bupropion can reduce tamoxifen's effectiveness.

Orlistat reduces absorption of roughly one-third of meal fat. In studies alongside a diet it produced about 3 kg more weight loss than placebo at one year, not a guaranteed individual outcome. High-fat meals worsen effects such as oily stools. Its own BMI criteria and contraindications must be assessed; it is not automatically suitable for a small amount of excess weight.

Wegovy's formal contraindications include hypersensitivity to the active ingredient or an excipient, but other product information also limits use. Semaglutide and liraglutide should not be used during pregnancy or breastfeeding. Tirzepatide is not recommended in pregnancy; use while breastfeeding may be considered individually. Before a planned pregnancy, stop semaglutide at least 2 months and tirzepatide at least one month beforehand.

Previous pancreatitis requires caution. Wegovy and Saxenda are not recommended with severe kidney or liver impairment. Tirzepatide requires no dose adjustment solely for this reason but does require caution in severe impairment. Gastroparesis means impaired stomach emptying: Wegovy requires caution and is not recommended when it is severe; tirzepatide requires caution with severe gastrointestinal disease. With insulin or sulfonylureas, we assess whether doses need reducing and glucose monitoring needs adjustment.

Which side effects are most common?

In the phase 3a trial summary in Wegovy product information, nausea occurred in 43.9% on semaglutide versus 16.1% on placebo, vomiting in 24.5%, diarrhoea in 29.7% and constipation in 24.2%. Gastrointestinal symptoms led 4.3% to stop treatment. Median nausea duration was 8 days, but symptoms may last longer or recur. Smaller meals, eating slowly and reducing fatty foods may help. Depending on the medicine and symptoms, the doctor may delay an increase or reduce the dose.

In that programme, gallstones were reported in 1.6%, gallbladder inflammation in 0.6% and confirmed acute pancreatitis in 0.2% on semaglutide. These figures describe particular trials, not all doses and patients. Rapid weight loss also favours gallstones. Severe pain under the right ribs or persistent upper abdominal pain needs medical assessment.

Symptoms requiring urgent medical attention

Seek urgent medical help if you cannot keep fluids down, have signs of dehydration, severe persistent abdominal pain, pain radiating to the back or jaundice. Do not wait for a review or for a full day to pass; pancreatitis can occur without vomiting. If suspected, the doctor withholds medication and arranges investigation. Sudden worsening or loss of vision needs urgent eye assessment even without diabetes: alongside retinopathy concerns, semaglutide carries a warning about NAION, an ischaemic optic nerve injury. Report sudden unexplained weight loss too. A life-threatening condition requires immediate medical help. Depending on the symptoms, other urgent situations may require medical help outside the clinic's opening hours as well. Clinic phone hours do not determine how long it is safe to wait.

How can you buy obesity medication safely?

Counterfeit pens have also been found in the EU's legal supply chain. Buy medication from a legal pharmacy, where the pharmacist verifies pack security features. Appearance and a batch number alone do not establish authenticity. Avoid classified adverts, auctions and private sellers. You receive an issued e-prescription code by SMS; check medicine availability with the pharmacy.

The dietitian starts with eating habits and daily routines: drivers, shift workers and people working from home have different needs. A deficit of around 500-750 kcal daily and 1-1.5 g protein per kilogram of reference body weight are often considered, but advice is individual. This is especially important with kidney or heart disease, older age and cancer treatment. Malnutrition or unintentional weight loss should not automatically be met with a calorie deficit. Appropriate fibre and fluids may help prevent constipation; amounts depend on tolerability and clinical advice, particularly with gastroparesis. We also discuss limiting red and processed meat in colorectal cancer prevention.

Resistance exercise twice weekly and regular walking are usually advised, adapted to fitness and health. A gym is not essential: bodyweight and resistance-band exercises are options. Activity helps protect muscle, improve function and maintain a lower weight.

How can a psychodietitian help with comfort eating after a shift?

Some people eat in response to stress after a night shift, an argument or a difficult day. Medication does not replace support for emotional eating. A psychodietitian helps identify these situations, plan meals and find other ways to manage tension. Suspected binge-eating disorder needs appropriate assessment; psychiatric consultation may also be advised. Medical and nutritional care are coordinated around the patient's plan.

A gram of alcohol provides about 7 kcal. A half-litre beer has roughly 250 kcal and 50 ml of vodka around 110 kcal, depending on the drink and strength. Alcohol calories can make a deficit harder to maintain; drinking may also impair sleep, raise blood pressure and reduce control over eating. This does not mean any amount automatically stops weight loss. However, alcohol is causally linked with cancers including those of the mouth, oesophagus, liver, colorectum and breast. Avoiding alcohol is best for prevention; less alcohol means lower risk.

We ask how much and how often you drink because this affects safety and tolerability. Alcohol may worsen gastrointestinal symptoms; with insulin or sulfonylureas it also increases hypoglycaemia risk. Any reduction plan is individual. Not requiring abstinence before seeking care does not mean there is a cancer-safe dose.

If cutting down is difficult, we offer assessment and appropriate help. Nasz Gabinet also provides alcohol dependence treatment in Bydgoszcz and addiction therapy. Naltrexone is used for alcohol dependence, but Mysimba, containing naltrexone and bupropion, does not replace that treatment and is not used during acute alcohol withdrawal. A doctor should plan care where withdrawal symptoms are a risk.

The initial and final doctor consultations and the two psychologist consultations take place by video. The five monthly medical reviews use the data in the app and do not involve a call. Before the initial consultation, the patient has blood tests done close to home and measures weight, waist circumference and blood pressure. Blood pressure needs to be measured with a cuff matched to the arm circumference, because a cuff that is too narrow can overestimate the reading. Dark, thickened skin in the armpits or groin may be acanthosis nigricans and needs assessment, so mention it to the doctor.

At the five monthly reviews, the doctor assesses effectiveness, tolerability and reported symptoms using the data in the app, without a call. After each such review the doctor issues an e-prescription, and its code arrives by text message.

A primary care doctor can diagnose and treat obesity, request tests within their remit and refer to a specialist when needed. Coordinated care for eligible coexisting conditions may include a dietitian. Public nutrition resources and online advice are also available, although these are not the same as a full treatment programme. Ask primary care or local authorities about current local programmes. In September 2026, Wegovy, Mounjaro, Saxenda, Mysimba and Xenical are paid for in full for obesity; reimbursement for other medicines, for example for diabetes, follows separate conditions.

NFZ screening colonoscopy without referral is for people without symptoms suggesting cancer who have not had colonoscopy in the past 10 years: ages 50-65, or 40-49 if a first-degree relative had colorectal cancer. Symptoms require diagnostic assessment, not screening. Screening mammography is usually every 2 years for women aged 45-74. After breast cancer, follow-up is set by the treating team; the programme also includes specific circumstances for annual checks.

NFZ tests and consultations are covered according to clinical indications and funding rules. A private recommendation does not automatically secure a free test or specialist outpatient appointment. A private doctor can, however, refer to hospital, and an oncologist generally does not require a referral. Bariatric surgery may be publicly funded after assessment at an appropriate centre. Our online programme costs PLN 1,799 for 6 months and includes consultations with a doctor and a psychologist, plus five medical reviews of app data without a call. Medicines are purchased separately.

The 2022 ASMBS/IFSO recommendations support bariatric surgery at BMI ≥35 irrespective of coexisting conditions, and at BMI ≥30 with type 2 diabetes. At BMI 30-34.9 it may also be considered when nonsurgical care does not produce durable improvements in weight or associated conditions. The bariatric team makes the final assessment and the centre confirms funding rules. NFZ reports 6,700 bariatric operations in Poland in 2024, more than double the 2017 number, with reimbursement expenditure rising fourfold to PLN 140 million.

With BMI 41 and type 2 diabetes, a surgical consultation can be considered at the outset, without a mandatory wait of over a year. Medication can be used alongside this process or to help prepare for surgery. We support preparation according to the team's recommendations, including glucose and blood pressure control, sleep apnoea assessment and psychological care. A hospital referral does not restrict choice to the patient's province.

Surgery can produce substantial, lasting weight loss and diabetes remission, but ongoing care remains necessary. Supplements and monitoring, including vitamin B12, iron, calcium and vitamin D, depend on the operation and results; supplements are often lifelong. Bone health and nutrition also need monitoring because deficiencies can initially be symptomless. SPLENDID's observational cancer findings are encouraging but do not guarantee protection.

The programme takes place online, so it is also available to patients from the region, including Solec Kujawski, Koronowo, Nakło nad Notecią, Inowrocław, Świecie, Toruń, Żnin, Chełmno and Tuchola. The patient talks to the doctor and the psychologist by video and has blood tests done close to home.

The patient has the screening colonoscopy and the mammogram at whichever centre nearest to home runs the programme, and all we ask is that the result is sent to us; we then put the date of the next test into the treatment plan.

The NFZ directory checked on 11 September 2026 listed three metabolic disease clinics in the Kujawsko-Pomorskie province, all in Bydgoszcz, including one for children. For August 2026, one of the other two clinics reported 7 people waiting, and the second reported 283. Both reported an average waiting period of 83 days. These are historical statistics, not a new appointment date. Confirm availability and the scope of adult obesity care with the clinic; children's queues are not compared with adult care.

This clinic category does not cover every public obesity-care option. People in Toruń and elsewhere can start with their own primary care doctor and obtain an appropriate referral. A private or public appointment does not itself change medicine reimbursement rules; pharmacies set full-payment prices. The Nasz Gabinet online programme includes consultations with a doctor and a psychologist, five medical reviews of app data without a call, an AI assistant and weight monitoring.