Obesity Treatment Gdańsk

Obesity is listed under E66 in ICD-10. The Polish Society for the Treatment of Obesity describes it in its 2024 guidance as a chronic, relapsing disease. After weight loss, changes in appetite regulation and energy expenditure can make a lower weight harder to maintain. Levels of ghrelin, which stimulates appetite, may rise, while leptin, which signals energy stores to the brain, falls as fat is lost. The extent of these changes and the course of the disease vary from patient to patient, so the treatment plan is tailored to each person. Care may continue for years, and we adjust its scope to results, tolerability and health. There can also be weeks without a fall in weight during treatment.

How does obesity develop and what contributes to it?

Obesity means an excess of body fat large enough to harm health. It usually develops slowly, over many years in which the body takes in more energy from food and drinks than it uses. The surplus is stored in fat cells. At first these cells grow in size, and when weight gain goes on for longer, the body produces new fat cells. Adipose tissue also releases hormones, including leptin, and substances that affect metabolism. An excess of this tissue can sustain chronic inflammation and reduce the sensitivity of tissues to insulin. Visceral fat, which collects around the abdominal organs, has the strongest effect of this kind.

The tendency to obesity is largely inherited. Twin studies attribute 40 to 70 percent of the differences in body weight between people to genes, and the disease often affects several members of one family. Inherited genes promote weight gain especially when high-calorie food is available at any time of day and the day is spent at a desk and in a car. Short sleep, chronic stress, shift and night work, pregnancy, menopause and quitting smoking also add to weight gain. Oral glucocorticoids and some antidepressants and antipsychotics can promote weight gain as well. Untreated hypothyroidism may make weight loss harder, but usually does not explain obesity on its own. During the consultation we therefore ask about medicines, thyroid disease, sleep, night work and alcohol.

What diseases and skin changes accompany obesity?

Obesity is associated with a greater risk of diabetes, high blood pressure, lipid disorders and fatty liver, although not every patient develops every complication. Friction, moisture, insulin resistance and other conditions affect the skin. In people with obesity, psoriasis and hidradenitis suppurativa may be more severe, and wounds may heal more slowly.

Obesity can be accompanied by changes in skin folds, acanthosis nigricans and flares of inflammatory skin disease. Some changes are painless, and patients may not connect them with their weight. We ask about them during the consultation; the doctor decides whether a photograph or an examination in person is needed. A video call does not provide the same skin assessment as an examination at a practice.

Weight, height, waist circumference and weight history form part of a clinical assessment. A man who is 178 cm tall and weighs 108 kg has a BMI of 34.1, calculated as 108 / 1.78². This is class I obesity under WHO thresholds: BMI from 25 indicates overweight, and 30, 35 and 40 mark successive obesity classes. BMI alone does not assess health fully: fat distribution, physical function and complication risks can differ at the same value.

We also measure the waist, midway between the lowest rib and the iliac crest, at the end of a relaxed breath out. For people of European descent, International Diabetes Federation thresholds are 94 cm for men and 80 cm for women. WHO values of 102 cm and 88 cm indicate substantially increased metabolic risk. Results are considered alongside other measurements and conditions. Before a remote consultation, the waist can be measured against bare skin. Incorrect tape placement can change the result in either direction; repeat it if uncertain.

We ask about weight around the age of twenty, when it began to rise, what was happening at the time, which diets and medicines were tried, and how much weight returned and how quickly. This history helps plan further care. Dark patches in skin folds may prompt an assessment of glucose metabolism, but skin appearance alone cannot diagnose a high insulin level.

When can medicine for obesity be started?

For many of the products discussed, BMI ≥30 meets the weight criterion, but the doctor also checks contraindications and health. At BMI ≥27 and below 30, indications depend on the product and a relevant accompanying condition. For Wegovy these include prediabetes or type 2 diabetes, high blood pressure, lipid disorders, obstructive sleep apnoea or cardiovascular disease. These are authorised indications in the summary of product characteristics, the official product information. Below BMI 27, medical assessment and nutritional treatment are still available, although the usual indications discussed here are not met. Xenical has different thresholds: BMI ≥30 or BMI >28 with additional risk factors.

The programme described is for adults. Age affects drug choice: Saxenda is not recommended from age 75, while Mysimba is not recommended above 75 and requires caution above 65. Data for Wegovy and Mounjaro from age 85 are limited. Severe kidney or liver impairment requires product-specific decisions: Wegovy and Saxenda are not recommended, while Mounjaro does not require a dose adjustment solely for this reason, but data are limited and caution is needed. Mysimba is contraindicated, among other circumstances, in end-stage kidney disease and severe liver impairment, current or previous seizures, current or previous anorexia nervosa or bulimia, and opioid use. These are not shared contraindications to every obesity medicine.

We treat patients from Gdańsk in an online programme that lasts 6 months and costs PLN 1,799. 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 buys the medicine at a pharmacy with an e-prescription, and its cost is not included in the price of the programme. The patient books each consultation in the Nasz Gabinet app, and the later dates are counted from the initial consultation.

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

Between consultations, the patient enters weight in the app once a week and body measurements once a month. The patient also takes a photo of the pen after the injection, and our medical team checks it. The doctor reviews these data before the check-up. The Polish Society for the Treatment of Obesity (PTLO) recommends treating obesity for a year or longer. After the programme, the patient can therefore extend treatment with a continuation package: 3 months for PLN 350. In the package, the patient receives an e-prescription every month after a medical review, without video consultations.

Dose increases depend on the product and tolerability. The injected Wegovy schedule from 0.25 mg to 2.4 mg takes 16 weeks; current product information also includes 7.2 mg for some adults. Mounjaro starts at 2.5 mg weekly, increasing to 5 mg after four weeks; further 2.5 mg increases are made if needed at intervals of at least four weeks. Adult maintenance doses are 5, 10 or 15 mg, so 15 mg is not a compulsory target. Saxenda is injected daily, starting at 0.6 mg and increasing in four steps at intervals of at least one week to 3 mg from week five if tolerated. Pen technique and injection-site rotation should be explained before treatment starts.

Check-ups cover home measurements, tolerability, symptoms and nutrition. The doctor determines dose changes and the timing of tests. Around 2 litres of fluid a day, 1.2 to 1.5 g of protein per kilogram of reference body weight and two resistance sessions weekly are examples that need adjustment for kidney or heart disease, physical ability and the ability to eat and drink. Severe vomiting or diarrhoea requires medical contact, especially if fluids cannot be kept down. Drinking more water alone is not sufficient in every situation.

Benefits and safety are assessed according to each product's rules. Adults should stop Saxenda if they have not lost at least 5% of their starting weight after 12 weeks on 3 mg. Mysimba should be stopped if at least 5% of starting weight has not been lost after 16 weeks, and Xenical if there is no such loss after 12 weeks. Mysimba subsequently requires at least annual reassessment of benefits, cardiovascular safety and maintained weight loss. Further care also depends on accompanying conditions and tolerability; changing or stopping medicine requires medical assessment. Reaching one year of treatment does not automatically mean reducing the dose.

When is a dermatologist or plastic surgeon needed?

• Chronic skin conditions such as hidradenitis suppurativa and psoriasis need dermatological care. A GP can initially assess changes in skin folds. Obesity treatment complements this care; the dermatologist should know about weight changes and medicines.
• We do not remove excess skin or provide aesthetic procedures as part of obesity treatment. A plastic surgeon assesses indications and weight stability using an examination and records.
• A description by telephone is insufficient to diagnose a skin lesion. The doctor decides whether a photograph could help or whether an examination by a GP or a dermatology consultation is needed.

The doctor chooses tests and their timing according to symptoms, conditions and planned treatment. Possible tests include a full blood count, fasting glucose or HbA1c, lipids, liver enzymes, TSH and creatinine with estimated kidney filtration, eGFR. Results help assess diabetes and liver, thyroid and kidney function. A primary care doctor may request NFZ-funded tests when needed for the care they provide; a private list does not guarantee that every test will be free. Raised liver enzymes may prompt an ultrasound, but normal results do not exclude fatty liver. Abnormal TSH may require FT4 testing. eGFR helps guide drug choice but is not the only basis for a decision. Pregnancy must be considered before treatment, and blood pressure and pulse monitored before and during Mysimba use.

Which tests may be useful for acanthosis nigricans and hair loss?

Dark, velvety thickening on the neck, in the armpits or groin can accompany insulin resistance and justify assessing glucose metabolism. HbA1c from 5.7 to 6.4% can support a diagnosis of prediabetes. A 75 g oral glucose tolerance test measures glucose after two hours, but is not automatically necessary with every such result or acanthosis nigricans alone. Routine fasting insulin measurement is not required to assess eligibility for obesity treatment.

For hair loss, the doctor reviews the rate of weight loss, diet and other symptoms. Depending on the history, tests may include ferritin with a blood count and C-reactive protein, vitamin B12 or TSH. Inflammation can raise ferritin and complicate assessment of iron stores. Hair loss may relate to weight loss, deficiencies or another cause; it is also a reported adverse effect of some medicines. Recurrent pus-filled lesions in skin folds may require dermatology and an assessment of inflammation, such as a blood count and CRP. No fixed panel explains every such symptom.

Further tests depend on symptoms. Abdominal ultrasound may be needed for suspected gallstones, and ECG or cardiology assessment for palpitations or breathlessness on exertion. Sudden or severe chest pain, marked breathlessness or impaired consciousness requires immediate help, without waiting for a planned test. Repeat tests depend on health, previous results and treatment progress, including when earlier results were normal.

Several mechanisms affect the skin in obesity. Friction and moisture in folds encourage intertrigo, which may be complicated by a yeast infection. High insulin levels can stimulate epidermal cells through IGF-1 growth-factor receptors and be associated with dark thickening in flexures. Inflammation related to excess adipose tissue may contribute to skin disease flares. Blood supply, swelling and other conditions also matter. Appearance alone does not always establish the cause.

A 2026 observational analysis of the US-based TriNetX database associated leg ulcers and lymphoedema with more bacterial cellulitis of the lower leg. Obesity, diabetes, venous insufficiency and athlete's foot were also relevant. Medical-record studies show associations but do not prove a single infection mechanism or predict an individual's outcome. Swollen lower legs and cracked skin between the toes need assessment and treatment of the cause alongside obesity care.

Dark patches on the neck, or acanthosis nigricans

Acanthosis nigricans causes symmetrical brown thickening with a velvety surface, most often on the neck, in the armpits and groin. It can look like dirt, but scrubbing does not remove it and irritates the skin. A 1992 Archives of Dermatology paper found it in 74% of 34 randomly selected adults at a US obesity clinic; their fasting insulin was higher than in the others. This small clinic sample does not establish prevalence in Poland. A 2023 prospective study of 319 people after sleeve gastrectomy included 141 with acanthosis nigricans. Changes improved in some patients after surgery alongside metabolic improvement; this cannot be assumed for every weight-loss method.

This appearance may justify investigating glucose metabolism but does not diagnose hyperinsulinaemia. Routine fasting insulin testing is not required for obesity-treatment assessment. A dermatologist chooses topical treatment for marked changes. Rapid onset, especially with unintentional weight loss, requires urgent investigation, including for cancer. This also applies to someone who still has obesity.

Painful lumps in the armpits and groin, or hidradenitis suppurativa

Hidradenitis suppurativa is a chronic inflammatory hair-follicle disease causing painful nodules, abscesses and sinus tracts, often in skin folds. It may resemble recurrent boils and needs dermatological diagnosis. A JAMA Dermatology study used Mendelian randomisation, an analysis based on genetic predisposition to higher BMI, and included 4,814 cases and over 1.2 million controls. The odds ratio was 1.20 per BMI unit: 20% greater odds, not a 20% increase in absolute risk. The result supports a causal relationship under the method's assumptions but does not say how much weight loss will change an individual's risk. Additional smoking analyses in that study were inconclusive.

The dermatologist decides about antibiotics, biological treatment or surgery. Weight reduction and smoking cessation may support care but cannot guarantee fewer flares. Reports of improvement with medicines acting on the receptor for the gut hormone GLP-1 come from small studies and case reports. Evidence remains preliminary and does not create a separate indication for these drugs in hidradenitis suppurativa.

Psoriasis in obesity and the effects of weight loss

Obesity is associated with more frequent psoriasis, greater severity and poorer responses to some treatments. A 2008 Italian trial included 61 people with obesity and psoriasis receiving low-dose ciclosporin; some were also randomly assigned a reduced-calorie diet. After 24 weeks, PASI75, an improvement of at least 75% in the psoriasis severity score, was achieved by 66.7% of the diet group and 29.0% of the drug-only group. Mean weight loss in the diet group was 7.0%. In a 2013 Danish trial of 60 people, the intervention involved eight weeks at 800 to 1,000 kcal daily and eight weeks gradually returning to 1,200 kcal. The between-group difference in weight reduction was 15.4 kg. The PASI difference was not statistically significant (P=0.06), while improvement in quality of life measured by DLQI was significant (P=0.02). Such a restrictive diet requires supervision and is not advice for self-treatment.

Weight reduction can complement psoriasis treatment but does not replace it. Doses of some biological medicines depend on body weight, so the dermatologist should know when obesity treatment starts and how it progresses. The treating doctor decides about changes to dermatological medicine.

Hair loss during rapid weight reduction and what to do

Hair loss during treatment may relate to the rate of weight reduction, nutrition, medicine or another cause. One possibility is telogen effluvium: a metabolic change shifts some follicles into a resting phase, with shedding two to three months later. Wegovy information for the 2.4 mg regimen reports hair loss in 2.5% of treated patients and 1.0% on placebo. The frequency at 7.2 mg differs. At 2.4 mg, reports were more frequent after losing at least 20% of body weight; symptoms were usually mild and often resolved while treatment continued. A meta-analysis of 41 papers covering 7,044 bariatric surgery patients reported 47% hair loss, with varying follow-up periods.

A 2026 meta-analysis included 17 studies and 1,091,743 patient exposures, not necessarily that many different people. The estimate for non-scarring alopecia from three cohorts was OR 1.40, meaning 40% higher odds in people using GLP-1 medicines, not a 40% rise in absolute risk. The authors discuss deficiencies after rapid weight loss as a possible contribution; this does not establish each patient's cause. Report marked hair loss to a doctor, who will assess diet, weight-loss rate, tests and continued medication. Improvement may take months. Patchy loss, inflammation, scarring or a severe problem warrants dermatology assessment without waiting six months.

Excess skin after substantial weight loss

Excess skin can remain after losing tens of kilograms. A 2024 histology study compared 80 samples taken during plastic surgery. It described similar collagen loss after weight reduction with and without bariatric surgery, and fewer elastic fibres in abdominal skin after bariatric surgery. It describes tissue structure; it does not show that excess skin depends only on kilograms lost or that treatment type is irrelevant.

An abdominal skin fold can cause chafing, persistent intertrigo and recurrent infections, and interfere with hygiene or movement. Document symptoms, previous treatment and weight changes for a surgical consultation. The centre assesses whether surgery is possible, its funding and the required period of stable weight using the indications and records. A purely cosmetic procedure is a different situation; describing chafing alone does not guarantee NFZ funding.

Injection-site skin and rotating injection sites

In weight-management trials of tirzepatide, injection-site reactions occurred in 8.0% of treated patients and 1.8% on placebo; 91% were mild. These findings do not rule out a severe reaction in an individual. Saxenda information describes injection-site cutaneous amyloidosis with an unknown frequency. A hard lump needs assessment and cannot be diagnosed from a description alone. Inject into the abdomen, thigh or upper arm as directed for the product, changing the site each time and avoiding lumps and affected skin. Increasing pain, spreading redness, discharge or fever needs urgent assessment. Unopened pens are generally stored at 2 to 8°C in a refrigerator, following the leaflet. Six weeks below 30°C after first use applies to multidose Wegovy FlexTouch; other packs may have different rules. Collect needles in a puncture-resistant container and take them to a facility accepting sharps. In Gdańsk, such waste is accepted at municipal selective waste collection points (PSZOK) and sorting centres, among others. A pharmacy with a medicine-return bin does not necessarily accept needles.

GLP-1 is a gut hormone released after a meal. It stimulates insulin release when glucose is high, reduces glucagon release, slows stomach emptying and affects fullness. Liraglutide and semaglutide act on its receptor. The semaglutide injections described here are weekly, while liraglutide injections are daily. Patients may feel full sooner, eat smaller portions and think less about food between meals. Tirzepatide acts on GLP-1 and GIP receptors; GIP is another gut hormone involved in the response to a meal.

In STEP 1, semaglutide 2.4 mg weekly over 68 weeks in 1,961 people without diabetes produced mean weight loss of 14.9%, compared with 2.4% on placebo. Both groups received dietary and activity advice. In SURMOUNT-1, involving 2,539 people over 72 weeks, tirzepatide produced losses of 15.0% at 5 mg, 19.5% at 10 mg and 20.9% at 15 mg, versus 3.1% on placebo. These are separate trials with different durations and conditions, not a direct comparison or a prediction for a patient. Individual responses varied; benefits and tolerability are reviewed according to the product used.

How long does treatment last, and what happens after stopping?

Appetite and weight can increase again after stopping. In the STEP 1 extension, a subgroup regained about two thirds of the weight lost within a year, and metabolic measurements moved towards baseline. Semaglutide and the lifestyle intervention ended together in that study. Treatment duration and stopping plans are individual. The study does not establish that gradual dose reduction prevents regain. Nutritional care, suitable physical activity and weight monitoring remain relevant afterwards; renewed gain calls for reassessment.

We discuss five commonly used products, but they are not all the medicines authorised for obesity treatment. Wegovy contains semaglutide. Its weekly injection schedule from 0.25 mg to 2.4 mg is described above. For adults with an initial BMI ≥30, product information allows 7.2 mg if needed after at least four weeks on 2.4 mg. Current authorisation also includes Wegovy tablets for adults, but authorisation does not confirm availability in a Polish pharmacy. Mounjaro contains weekly tirzepatide: 2.5 mg is the starting dose and 5, 10 and 15 mg are adult maintenance doses. Saxenda contains daily liraglutide, with a target of 3 mg. Mysimba tablets combine two substances, naltrexone and bupropion. Contraindications include seizures, uncontrolled high blood pressure, current or previous anorexia nervosa or bulimia, acute alcohol withdrawal and opioid use. Xenical is a 120 mg hard capsule containing orlistat, which reduces absorption of roughly one third of meal fat. Excess dietary fat worsens oily stools; absorption of vitamins A, D, E and K may fall, so supplementation can be considered. Combining orlistat with ciclosporin is not recommended; if necessary, ciclosporin levels require monitoring. Ozempic also contains semaglutide but has authorisation for type 2 diabetes, distinct from Wegovy.

Medicine costs depend on the pharmacy, dose, formulation and number of packs. Check the current price for the prescribed pack; prices of lower doses do not determine the cost of 7.2 mg or Wegovy tablets. Four weekly doses last 28 days, which is shorter than most calendar months. Wegovy, Mounjaro, Saxenda, Mysimba and Xenical were not found in the reviewed reimbursement list effective from 1 July 2026 and its update. Reimbursement for the particular product and indication should be checked when prescribing. Buy prescription medicines from a pharmacy. Poland's Chief Pharmaceutical Inspectorate has warned about counterfeit semaglutide pens; a suspiciously cheap offer outside a pharmacy increases the risk of buying a counterfeit.

How do skin conditions affect medicine choice?

We consider skin disease, previous drug reactions and other medicines. Mysimba can cause itching, rash, sweating and hair loss; severe skin reactions requiring withdrawal and urgent help have also been described. Orlistat may cause hypersensitivity with urticaria or blisters. Daily liraglutide means more injections than a weekly regimen. Local reactions and hair loss have also been reported with semaglutide and tirzepatide. Separate adverse-effect tables cannot establish which drug will suit an individual's skin best.

Other conditions, kidney and liver function, preferred route and budget also guide the choice. Effectiveness should be discussed for each product. In COR-I, naltrexone with bupropion produced mean weight loss of 6.1% after 56 weeks, compared with 1.3% on placebo. Orlistat has been associated with about 2 to 3 kg more loss than placebo after a year. Different trials do not compare all products under identical conditions, and their findings cannot be assigned to every oral medicine.

Obesity medicines are not used during pregnancy. Stop semaglutide at least two months and tirzepatide at least one month before a planned pregnancy. Effective contraception is needed during treatment; discuss the method and any additional protection with tirzepatide with the doctor. EU product information does not require an additional barrier method for four weeks in every patient. If pregnancy occurs during use, stop the medicine and contact a doctor urgently. Wegovy and Saxenda should not be used while breastfeeding; current Mounjaro information permits individual consideration. Previous pancreatitis calls for careful assessment but is not an automatic shared prohibition for all products. The doctor needs to know about a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 (MEN2). The US prescribing information lists these conditions as contraindications. EU product information, which applies in Poland, does not list them as contraindications, so the doctor assesses the risk individually.

Semaglutide information for the 2.4 mg regimen reports nausea in 43.9% versus 16.1% on placebo, diarrhoea in 29.7% versus 15.9%, vomiting in 24.5% versus 6.3%, and constipation in 24.2% versus 11.1%. Symptoms often ease, but severe or persistent symptoms should not simply be waited out. A doctor may adjust dose escalation to tolerability. Gallstones occurred in 1.6% and confirmed acute pancreatitis in 0.2% of treated participants in the trial programme described. Pain beneath the right ribs, fever or yellow skin needs urgent assessment. With severe vomiting or diarrhoea, contact a doctor before the next dose, since dehydration can impair kidney function. Persistent vomiting, increasing bloating and inability to pass wind require urgent medical help because of possible obstruction. Rapid improvement in glucose can temporarily worsen existing diabetic retinopathy; the doctor sets eye-review dates. Sudden loss or marked deterioration of vision requires urgent assessment.

GLP-1 or GIP/GLP-1 medicines with insulin or a sulfonylurea may increase hypoglycaemia risk. The doctor adjusts doses using readings and plans glucose monitoring. Blood-pressure medicines may also need adjustment during weight loss according to readings and symptoms. If you feel dizzy on standing, measure your blood pressure and report the symptoms to a doctor. Do not change these doses yourself.

Which skin symptoms require immediate action?

A widespread rash with fever, blisters or mucosal erosions may indicate a severe drug reaction, including Stevens-Johnson syndrome. Stop the suspected medicine and seek urgent hospital assessment. Sudden tongue or throat swelling, especially with breathing difficulty, requires immediate emergency help. Spreading redness and warmth of a lower leg with fever need urgent infection assessment. Every new foot wound in someone with diabetes needs urgent examination; do not wait two weeks. Severe infection, blackening skin or signs of poor blood supply require immediate help. Severe persistent abdominal pain, especially radiating to the back with vomiting, may indicate pancreatitis; stop the drug, as these symptoms require urgent medical help. Complete inability to pass urine also requires urgent medical help; low urine output with dehydration is a different symptom that also needs assessment. Impaired consciousness requires immediate medical help.

Even with a reduced appetite, meal composition matters. A dietitian can help match food to health, routine and energy needs. A daily deficit of 500 to 750 kcal is an example of an individual plan, not advice for everyone. The rate of loss is assessed against starting weight, nutrition and symptoms; a threshold of 1 kg weekly alone does not establish safety. Very rapid loss can contribute to muscle loss, deficiencies, gallstones and hair shedding. Greater initial loss during medicine use needs assessment, especially with low food intake or poor tolerability.

Protein, iron and zinc during rapid weight loss

An example range of 1.2 to 1.5 g protein per kilogram of reference body weight needs adjustment for factors such as kidney function and nutritional status. The reference weight used in calculations need not be the patient's personal target. Protein spread across meals supplies building material for muscles, skin and hair. Depending on diet and symptoms, iron stores, vitamin B12 and sources of zinc are assessed, particularly with little meat consumption. A doctor or dietitian chooses supplements using results, diet and other indications; excess amounts of some nutrients can harm. After bariatric surgery, regular supplements according to the centre's guidance are needed. Fluids also need to suit health. Vomiting with an inability to drink requires medical help.

Psychodietetic support can help when eating follows stress, happens at night or reflects fear after previous unsuccessful diets. Work with a psychodietitian (a dietitian trained in the psychology of eating) involves recognising triggers and finding other responses. Binge eating with loss of control may require diagnosis and psychological or psychiatric care. Obesity and eating-disorder treatment should be planned together. Psychological support can complement surgical care when appearance after substantial weight loss is difficult to accept.

A gram of pure alcohol provides 7 kcal. Three half-litre beers can provide around 700 kcal, depending on the product. This extra energy can make a calorie deficit harder to maintain. Alcohol may also worsen psoriasis control, wound healing and liver health, and increase nausea and vomiting during treatment. The extent varies. In someone using insulin or a sulfonylurea, drinking without food increases hypoglycaemia risk.

Mysimba is contraindicated in circumstances including opioid use or dependence and acute alcohol withdrawal, because bupropion lowers the seizure threshold. We therefore ask about drinking when assessing medicine suitability. Problematic drinking requires a safe plan for both conditions; the order of care depends on health. Information about help with alcohol problems is available on our pages about alcoholism treatment in Gdańsk and addiction therapy. The appropriate form of care is agreed individually.

We run the whole programme online, including for patients from Gdańsk. At the initial consultation the doctor discusses the history, test results and home measurements, then decides whether the patient can be treated in the programme. A prescription follows assessment of suitability. Weighing is best done in the morning after using the toilet; take blood pressure twice, one to two minutes apart, after five minutes sitting quietly. Tests can be done locally; preparation, including fasting, depends on the requested test.

An examination in person may be needed for unreliable measurements, swelling, suspected liver enlargement, an irregular pulse or a skin lesion difficult to assess on camera. A cuff that is too narrow can overestimate blood pressure, and misplaced tape alters waist readings. The doctor determines where and how urgently such an examination is needed. Whether the patient can be treated in the programme depends on its result.

If the doctor considers a photograph useful, take it in daylight without flash, both close up and from farther away to show the location. A ruler beside the lesion helps show size. Agree a secure way to send the image with the practice. A photograph does not allow palpation or assessment of every feature; uncertainty requires an examination or dermatology consultation.

The initial 30-minute doctor consultation is included in the programme, along with a final 30-minute doctor consultation, two online psychologist consultations lasting 40-50 minutes each and five medical reviews of app data without a call. The doctor determines the next steps, which may include tests, treatment or another specialist.

A primary care doctor can request NFZ-funded tests when needed for the care they provide. The CHUK cardiovascular prevention programme is for people aged 35 to 65 who meet its criteria, including at least five years since previous participation and no Moje Zdrowie check in the preceding 12 months. Diabetes, chronic kidney disease, familial hypercholesterolaemia and certain cardiovascular conditions exclude eligibility. If you have cardiovascular disease, check eligibility with a doctor. It includes measurements, lipids, glucose and risk assessment. Since May 2025, Moje Zdrowie has offered checks from age 20: every five years up to 49, and every three years from 50. Primary care confirms eligibility.

NFZ dermatology normally requires a referral from a doctor working within public insurance, with statutory exceptions. Records of symptoms and past treatment help the assessment but do not guarantee a referral without further examination.

Wegovy, Mounjaro, Saxenda, Mysimba and Xenical were not found in the checked reimbursement list effective from 1 July 2026 and its update. Reimbursement is specific to a product and indication; coverage of a different semaglutide product in type 2 diabetes does not mean Wegovy is covered. The NFZ also funds obesity complications and bariatric surgery after assessment. The relevant centre assesses funding for excess-skin removal using indications and records; a purely cosmetic procedure is a different situation.

Some eligibility rules for bariatric surgery use BMI ≥40, or BMI ≥35 with an obesity-related condition such as type 2 diabetes, obstructive sleep apnoea or high blood pressure. These are not the only situations that justify a bariatric consultation, and not every patient needs months of unsuccessful non-surgical treatment first. ASMBS/IFSO 2022 guidance includes BMI ≥35 regardless of accompanying disease and consideration at BMI 30 to 34.9 in relevant metabolic circumstances. The Polish 2025 consensus also gives BMI ≥35 regardless of overt obesity-related disease, and consideration at BMI 30 to 34.9 with type 2 diabetes inadequately controlled despite treatment. Clinical guidance differs from NFZ funding rules. The centre assesses indications, physical function, nutrition and funding for the proposed procedure.

Check consultation and operation dates with the centre. Preoperative weight loss may reduce fatty liver volume and help surgery; the team sets its extent. Diabetes control and treatment of skin infections, especially near the operative site, matter. Long-term reviews, supplements and nutrition suited to the procedure are needed afterwards. The stages of returning to normal food texture are separate from guidance for later years. The hair-loss meta-analysis discussed above reported 47% after bariatric surgery across different follow-up periods. Symptoms and nutritional status determine tests such as ferritin and vitamin B12.

The surgeon determines the timing of skin surgery and required weight stability; further weight changes may alter its result. Before general anaesthesia or deep sedation, tell the team about GLP-1 or GIP/GLP-1 treatment, since slower stomach emptying may increase aspiration risk. The 2024 multisociety statement recommends individual risk assessment; many patients can continue medication. With greater risk, the team may advise a liquid diet for at least 24 hours, gastric ultrasound or other preparation, including temporary withholding. Do not skip doses yourself; agree preparation with the surgical team once the operation is scheduled.

Remote consultations can improve access for residents of Pruszcz Gdański, Tczew, Starogard Gdański and smaller communities in Kashubia, Żuławy and Powiśle. Tests can be done near home, and measurements and results discussed with the doctor at a video consultation. Plans are individual, and e-prescriptions depend on suitability. Check the dispensing deadline on the prescription: standard validity, annual prescription rules and any future dispensing start date differ.

Seafarers, port workers and drivers should discuss work patterns, travel duration and the dates of the programme consultations before treatment. Shift work does not automatically call for a weekly drug. The product and supply for a journey depend on medical assessment, storage and access to help. Unopened pens generally need refrigeration according to the leaflet. Six weeks below 30°C after first use applies to Wegovy FlexTouch, not every semaglutide product. Before a voyage, the doctor assesses tolerability of the current dose and agrees what to do about symptoms; do not increase doses yourself while away.

Check NFZ obesity care with a clinic that accepts adults. NFZ directory entries in the metabolic diseases clinic category also include children's clinics and other diagnoses. The 11 September 2026 review found four such entries in Pomerania. Two of them, one in Gdańsk and one in Chojnice, covered patients aged 0 to 18, and the Gdańsk entry concerned a phenylketonuria clinic. These are therefore not four confirmed adult obesity services. For August, the other Gdańsk clinic reported 336 people waiting and an average wait of 135 days, and a clinic in Gdynia reported 770 people and 187 days. Both clinics need to confirm that they accept adults with obesity. The average concerns people removed from the list in the reported month, while the number waiting reflects the end of that month. Neither figure is the next available appointment.

In our online programme, the patient books the date of the initial consultation in the Nasz Gabinet app. The patient pays the full price for the medicine at the pharmacy, which depends on the product and the pharmacy; the price of the programme does not cover it. The Association of Polish Surgeons directory checked on 11 September 2026 listed six bariatric centres in Pomerania, including three in Gdańsk. Listing does not guarantee a current NFZ contract or appointment. The centre assesses eligibility, including below BMI 40, according to health and applicable rules.